September 28, 2013 10:19:01 PM
JACKSON -- Beginning Tuesday, some Mississippians can sign up for new health insurance policies on the state's federally-run health insurance marketplace.
With Gov. Phil Bryant opposed to the federal health care overhaul, state government is mostly on the sidelines in the effort. That's left a coalition of health advocates, churches and others to push the new law.
Already, some Mississippians have received letters inviting them to sign up. Others might hear about the marketplace at church, a doctor's office, or even the state fair. Supporters hope the first people to sign up will be enthusiastic and tell their friends, boosting a modest marketing budget through word-of-mouth.
Insurance coverage will start Jan. 1 for those who sign up by Dec. 15. The initial enrollment period will continue through March 31.
A 2012 study by the Mississippi Center for Health Policy estimated that as many as 275,000 Mississippians could gain insurance through the online marketplace, with 230,000 getting federal tax credits to help pay for it. But no one's sure precisely how many people will sign up or how quickly.
People with incomes between the federal poverty level and four times that amount will be eligible for federal tax credits, on a sliding scale, to help pay for coverage in the online marketplace. That's a yearly income of $11,500 to $46,000 for an individual and $23,500 to $94,000 for a family of four. Those with incomes at the top of those at the top of those scales will get little or no subsidy.
People with incomes below poverty level will get no aid from the exchange. Uncovered adults were supposed to be helped by an expanded Medicaid program, but Mississippi leaders chose not to expand that health program.
Bryant also blocked Insurance Commissioner Mike Chaney's efforts for Mississippi to run its own health insurance exchange, leaving the federal government to run the market. At first, it appeared some counties would get no coverage at all, until Chaney and federal officials persuaded at least one company to cover all 82 counties.
Humana Corp. will cover 40 counties, while Magnolia Health Plan, a unit of St. Louis-based Centene Corp., will serve 46 counties. The two will compete only in Hinds, Madison, Rankin and DeSoto counties.
The sticker price of those plans will be relatively expensive compared with that of other states. The estimated cost of a mid-range plan will be $448 a month in Mississippi, third-highest of 47 states outlined in a Department of Health and Human Services report. The two highest are in Wyoming and Alaska.
But that HHS analysis shows prices could be quite low after tax credits. For example, a family of four making $50,000 a year would pay $282 a month after the subsidy, which saves them nearly $800 a month.
"When you factor in the tax credit, it is affordable," said Roy Mitchell, executive director of the Mississippi Health Advocacy Program. The group is part of the statewide coalition Cover Mississippi, which will encourage uninsured people to sign up though the exchange.
Their efforts will supplement those of the University of Mississippi Medical Center, which received $831,000 from the federal government to train navigators to help with enrollment. UMMC chose to use its money to focus on its own patients, instead of launching a broad outreach program. It has trained existing financial counselors and will hire four more.
"Because we're the only academic medical center, people come from all across the state for tertiary care," spokesman Jack Mazurak said.
The grants went out in mid-August, and UMMC is still putting together its program. The hospital has sent 3,000 letters to uninsured people who have been to UMMC in the past and who fit the income and family-size requirements. Officials say they eventually hope to train other hospitals and hospital financial managers.
The other group training navigators is Oak Hill Baptist Church in Hernando. The Rev. Michael Minor, the church's pastor, says it has trained 19 paid navigators and hopes to train more as volunteers. Oak Hill is trying to expand its focus from 21 counties to a broader portion of the state.
There will be other allies. For example, federally-financed health centers received money to train certified application counselors. The Jackson-Hinds Comprehensive Health Center is targeting 16,000 clients who are uninsured, said CEO Jasmin Chapman. She's also going to send counselors after hard-to-reach groups such as college students.
"It's going to be hard," Chapman said. "Some of the people we're trying to get are ones that may not see the need."
Observers say they expect an initial rush from people who haven't been able to get insurance because of pre-existing conditions or haven't been able to pay current rates. Another bump in enrollments is likely before Dec. 15, the deadline to sign up for coverage.
"The first people to come will be the people we get calling our office every day who are just looking for some sort of coverage," Mitchell said.