Mississippi’s health insurance exchanges will look different than the Obamacare model

Grant funds from the federal government are available to set up the health insurance exchanges (HIEs) that are key provisions of the controversial Patient Protection and Affordable Care Act informally known as Obamacare.

States that fail to do so will later be required to use HIEs formed by the federal government. Ironically, Arkansas has a Democratic governor, but that state has yet to even apply for grant funds to establish the HIE. Mississippi may be getting HIEs far sooner as a result of actions by Republican Gov. Haley Barbour.

Barbour advocated for health insurance exchanges before Obama was even elected president.

“Since 2007, I have advocated for a health insurance exchange that meets the needs of Mississippi, not what is right for Washington,” Barbour said. “The state Senate passed legislation to implement an exchange in 2008 at my request. This was before President Obama took office and much earlier than Obamacare was enacted.”

Barbour supported Insurance Commissioner Mike Chaney applying for a grant to establish an exchange, and the state received $20 million—one of the highest awards received by a state. But Barbour said Mississippi’s HIE will be very different from the health exchange envisioned by Obamacare or the one in Massachusetts.

“Mississippi will create a voluntary, market-driven exchange for small businesses and individuals that allows consumers the flexibility to choose the private insurance plan that best fits their needs,” Barbour said.

U.S. Sen. Thad Cochran has supported efforts in Mississippi to set up a health insurance exchange.

“I am proud of Gov. Barbour's work to craft an insurance exchange program tailored to improve access to healthcare in our state,” Cochran said. “Access to affordable healthcare and insurance are among the challenges faced by many Mississippians.”

The Mississippi Hospital Association (MHA) is engaged in an ongoing dialogue with the Mississippi Insurance Department and other stakeholders regarding the state HIE. 

“We feel it is extremely important for our healthcare community to come together and be involved as the HIE takes shape,” said Shannon Coker, director of Advocacy and Communications, MHA. “The organization of the exchange will greatly impact our hospitals and the patients in our communities. Hospital leaders are well educated on the issues that affect our hospital community and must have a voice in the program implementation.”

Coker said local and federal officials need to understand and grasp hospital concerns that could have a huge impact on access to quality healthcare.  Currently, MHA is planning upcoming programs, communication and events to make sure all of the regulatory agencies and hospitals continue discussions and work toward fulfilling the needs of the federal mandate in a way that is tailored toward Mississippi.

Lanny Craft, executive director, Mississippi Comprehensive Health Insurance Risk Pool Association (MCHIRPA), said the HIEs will be a significant issue for states and state’s populations over the coming years. Right now, more than two years out for the HIEs to go into effect, there are many unknowns. When laws are written, then the appropriate agency has to interpret and implement the law. Craft said the final regulations haven’t been determined yet. The proposed regulations are out for public comment.

MCHIRPA has been selected by Commissioner Chaney to establish the HIE in Mississippi. That organization has 20 years experience running the state’s high-risk health insurance program. Mississippi is one of 34 states operating such programs for the purpose of allowing access to medical coverage for those people who can’t purchase private health insurance because of a pre-existing health condition or other issues.

The HIE envisioned by the Affordable Health Care Act passed in 2010 was to provide health insurance access to any individual and small groups needing coverage.

“The Affordable Health Care Act says these things must be established and operated by a state agency or a non-profit,” Craft said. “In our case, we are a non-profit legal entity.”

Basically what the exchange would do is provide a marketplace where a person could shop for alternatives for health coverage. While it might not include all alternatives, it would provide a place for consumers to shop (mostly online) for plans that would be ranked by the level of coverage provided ranging from the low end, bronze, to silver, gold and platinum plans. People would be able to get information to determine which plan and company they prefer.

Craft said the HIE will probably look similar to the government program for providing information online about the Medicare supplement plan or Medicare Part D drug plan.

It could make it easier to make good decisions by being able to compare similar plans and costs, something that can be difficult today. And companies participating must have appropriate pricing. Rates will be closely monitored, and only a certain percentage of premiums will be allowed to go for administration.

Another potential advantage to the HIE is that businesses could allow employees to pick which plan suits them best. The business would pay a certain amount for insurance premiums, and the employee could decide what level of insurance to purchase.

“It would give people more choices,” Craft said.

A provision of Obamacare requiring people to purchase health insurance or face penalties has been controversial, and is being challenged in court. The HIE might be valuable even if the mandatory purchase of insurance is deemed unconstitutional.

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