Mississippi jumps onboard the state-based exchange bandwagon as well!

Just yesterday I noted that the Michigan state senate has passed a bill to establish a state-based ACA exchange, joining 21 other states (Georgia is scheduled to launch theirs this fall, and Illinois in time for the 2026 Open Enrollment Period). The bill now moves to the state House, where I'm expecting it to pass and be signed into law by Gov. Whitmer without too much controversy. If so, Michigan would also split off of the federal exchange in time for the 2026 OEP.

Well, it turns out that another state may end up beating Michigan to the punch, and it's probably the last state you'd expect it to happen in: Mississippi!

From April:

Thousands of you have health insurance you bought through the marketplace, healthcare.gov. However, state lawmakers are looking at whether they could improve your options and save you money in the process.

Right now, if you buy insurance off the marketplace, that program is run by the federal government.

“If you have a state-based exchange, you can lower the cost of insurance for folks who buy off the exchange,” explained Insurance Commissioner Mike Chaney.

Lawmakers say that moving to a state-run exchange could mean more options for you.

“What we’re trying to do is incentivize more insurance companies to participate and to offer better policies for the people that fall within those categories that could benefit from it,” said HB 1647 author Rep. Trey Lamar when presenting the legislation.

...Roy Mitchell is hopeful that a move to the state plan could result in increased marketing and more navigators for those who stand to benefit from it. Insurance Commissioner Mike Chaney says that not only could a state-run plan be more affordable for people, it could save the state.

“We may pick up anywhere from 25 to 35 million dollars a year in income with which we’re paying to the federal government today,” explained Chaney.

Cut to a month later:

This bill authorizes the Commissioner of Insurance to establish and operate a state insurance exchange in Mississippi. The bill enables the Commissioner to create advisory boards, accept federal funding, and implement necessary rules and regulations for the operation of the insurance exchange.

It also establishes the "Mississippi Health Insurance State Exchange Trust Fund," from which money can be expended for the creation or operation of the exchange.

Furthermore, it stipulates that fees assessed on insurance premiums sold on the exchange will contribute to this fund. The Comprehensive Health Insurance Risk Pool Association and Comprehensive Health Insurance Risk Pool Board are permitted to develop and fund an online portal to assist consumers in selecting a health insurance plan. Additionally, the bill provides for amendments to the Mississippi Code to align it with these new provisions.

Last Action: Law W/out Governor's Signature (on 05/14/2024)

Lo and behold:

...House Bill 1647

...BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. For the purposes of this act, the following words and phrases shall have the meanings as defined in this section unless the context clearly indicates otherwise:

(a) "Exchange" means a state, federal, or partnership exchange or marketplace operating in Mississippi pursuant to Section 1311 of the Federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and regulations and guidance issued under those acts.

(b) "Comprehensive Health Insurance Risk Pool Association" means the mechanism as established in Sections 83-9-201 through 83-9-223.

(c) "Comprehensive Health Insurance Risk Pool Board" shall have the same meaning as provided in Section 83-9-205(b).

It's worth noting that Mississippi actually has had the framework for a fully-functional state-based exchange, called (cleverly enough) "One Mississippi," for over a decade. Unfortunately it was never actually implemented and has basically been mothballed since 2013. However, this could be retooled & set up as the basis for the new state-based exchange in the future.

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