How much more are ~310,000 MISSISSIPPI ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at MISSISSIPPI:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

Enrollment at practically all income brackets has dropped, in most cases plummeting by double digits...and even in the one bracket where it increased, it did so by a nominal amount (literally 10 people). Basically just a sea of red (OK, I use orange to make the black text more readable in contrast to the background).

Overall plan selections were already down more than 7% out of the gate, with nearly 25,000 Mississippians losing coverage before it even kicked in:

OK, onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

As a result, the overall Actuarial Value of Mississippi enrollees actually dropped substantially, from 85.5% to 79.8% as the enrollees who weren't priced out of coverage entirely downgraded to worse plans: Enrollment in "Platinum-equivalent" high-CSR Silver plans dropped off by 26 - 29%, while enrollment in Gold plans fell off a cliff, dropping by more than 50%.

Meanwhile, enrollment in high-deductible Bronze plans jumped by over 77% and standard Silver went up by ~19%.

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

Even the mad scramble to "buy down" to cheaper, crappier coverage still resulted in the ~310,000 enrollees who signed up during Open Enrollment having their net premiums MORE THAN TRIPLE on average, from $41/mo to $131/mo. That's more than $1,000 more in premiums per enrollee per year.

Adding insult to injury: Downgrading to worse coverage has also resulted in out of pocket expenses DOUBLING, for a combined average healthcare cost increase of ~140%.

That's an increase from less than $1,500 to more than $3,500 per enrollee this year...nearly $2,100 more apiece.

In addition, based on KFF's net data, average deductibles also increased by a stunning ~78% to nearly ~$3,100 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: MISSOURI.