In the latest development, the U.S. Department of Health and Human Services pulled out of meetings around the state organized by the Mississippi Health Advocacy Program. Those meetings were cancelled, with Health Advocacy Program Director Roy Mitchell citing the refusal as the latest evidence of efforts to torpedo the health law by President Donald Trump’s administration.

“This is just clearly sabotage,” Mitchell said. “It’s still the law of the land, but they’re pulling out.”

The move drew national attention, and the department wasn’t shy about it.

“The American people know a bad deal when they see one and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford,” department Press Secretary Caitlin Oakley said in a statement. “As Obamacare continues to collapse, HHS is carefully evaluating how we can best serve the American people who continue to be harmed by Obamacare’s failures.”

The state’s two navigator groups, which help people sign up for individual coverage, are dealing with budget cuts, which could hurt their ability to sign up customers during an enrollment period that’s been cut from three months to six weeks. Also, the Trump administration cut its national marketing budget from $100 million to $10 million.

“It’s not just the pre-enrollment meetings,” said Caitlin Rehner, who runs a navigator program at the University of Southern Mississippi’s School of Social Work. “It feels like everything that’s happening is to provide us with less support, less resources.”

Rehner said her group’s budget was cut 10 percent, which will reduce travel across 24 south Mississippi counties that its three navigators cover.

The Rev. Michael Minor, whose Hernando-based Oak Hill Baptist Church Ministries has a total of 40 full-time and part-time navigators, won’t say by how much his budget was cut. He said his employees are relying on relationships they have built.

“I think we have trusted voices,” Minor said. “Our navigators have been working since 2013. They’re known in their communities.”

Mitchell warns that less marketing could mean fewer younger, healthier people in the pool, burdening insurers with higher average costs for older, sicker people.

Already, Mississippi is down to only one insurer statewide, with Humana Inc. pulling out after this year. Though most people get federal tax credits and won’t feel the bite, state Insurance Commissioner Mike Chaney approved a 47 percent rate increase for that company, St. Louis-based Centene Corp. Chaney said that amount was necessary to cover potential costs should the Trump administration stops paying cost-sharing reductions to insurers, as it has threatened to do.

“I think your major worry needs to be that we keep Centene in the business they’re in,” Chaney said, adding he plans to cut the rate increase to 17 percent if cost-sharing reductions continue.

For the small share of Mississippians who pay the going rate on the marketplace, that means a big jump in monthly premiums. But more than 90 percent of enrollees get tax credits and won’t be hurt. For example, the Kaiser Family Foundation says a 40-year-old nonsmoker who makes $30,000 a year will pay $201 monthly for the second-lowest priced silver plan, actually down from $208 monthly this year.

But even with aid, many Mississippians struggle to pay premiums. Kaiser says 67,000 people were enrolled in February, but Chaney said Centene and Humana tell him only about 29,000 people are currently covered, meaning a majority of people failed at some point to pay premiums.

“If there’s $30 toward health insurance or $30 toward your power bill, people are going to pick the power bill every time,” Rehner said.

But with only one insurer, Rehner and Minor said people who just stopped paying bills instead of formally terminating coverage will be required to make up missed premiums if they try to re-enroll.

“It wasn’t fair to the insurance company for someone to get coverage because they had a certain health situation, then drop it, and then re-enroll,” Minor said.