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Federal market exchange lacks health insurance providers for 36 counties

It’s well past halftime and the clock can’t be stopped as federal officials seek health insurers to cover 36 Mississippi counties before an Oct. 1 deadline for launching the state’s healthcare exchange.

The Mississippi Department of Insurance is unsure what to make of a predicament it has no control over. Gov. Phil Bryant quashed Insurance Commissioner Mike Chaney’s effort to build the digital exchange late last year with a threat to sue the Department of Health and Human Services. He added in a refusal to allow the state’s Division of Medicaid to take part in preparing the insurance marketplace.

“The commissioner has authority to establish an exchange, but was denied the state operation by the federal government due to the governor’s action,” said Chaney, whose department had worked on the exchange going back to Haley Barbour’s gubernatorial administration before having to call it quits

healthcareThe commissioner, in an email last week, said the best information he has indicates the federal exchange, or what is officially called the Federally Facilitated Marketplace, will open for enrollment in 46 of Mississippi’s 82 counties on Oct. 1.

Of the 46 counties that will open for enrollment, four — Hinds, Rankin, Madison and Desoto — will have two insurers from which to choose, Humana and Magnolia Health Plan. The remaining 42 will have a single provider.

And the 36 remaining counties?

No one can say what will become of them, least of all the Mississippi Department of Insurance. “We’re not really sure, to tell you the truth,” one department official said.

If the feds know, they aren’t letting on.

In what appeared to be a general statement that did not specifically address where people in the 36 counties can turn to for coverage, Health and Human Services Department spokesman Lee Millman said: “Starting on Oct. 1, all Americans will be able to apply for quality affordable coverage in the marketplace.”

Time has expired for potential insurance providers to apply to cover Mississippi’s counties. The Department of Health and Human Services could be reviewing more applications that if approved could possibly give uncovered counties a provider. This is unlikely based on the dearth of providers interested in the state, however.

Chaney and his staff have watched from the sidelines, but the work they preformed on the market exchange before Bryant pulled the plug has helped the department “to effectively monitor implementation of the federal exchange in Mississippi,” he said.

This is important from a regulatory standpoint, according to Chaney. “HHS essentially controls all areas of development and establishment,” he said, though he added his department retains its traditional regulatory role.

The department “continues to review the rates and forms of all health insurance plans sold in the state, including on the exchange,” Chaney said.

Light brown counties have no overage available.

Light brown Mississippi counties have no overage available.

The department, he said, tries to “maintain as much state control as possible, but is very limited in authority over the federal plan.”

He said another benefit of the Insurance Department’s previous work is the research it did on small employers offering insurance coverage to employees, self-employed individuals, and characteristics of the uninsured population and other hard-to-reach population groups. The information gathered could help the Insurance Department to implement a small business coverage plan without federal assistance, “if the state chooses to do so,” Chaney said.

Whatever Chaney does, he can expect Bryant to offer stiff resistance – if the department’s effort does anything that appears to abet the Affordable Care Act, or Obamacare, as it is also known.

In a blunt February statement, Bryant insisted the market exchanges “are a portal to a massive and unaffordable new federal entitlement program.

“They trigger new taxes on businesses and will ultimately drive more people onto Medicaid rolls. I firmly maintain my position that Mississippi will not willfully implement a mechanism that will compromise our state’s financial stability.”

Around the same time, Bryant suggested in a Kaiser Health News interview that uninsured Mississippians have sufficient heath care coverage through hospital emergency rooms.

The website of right wing group Freedom Works recently hailed Bryant’s place among the 27 governors who have refused to participate in preparing the marketplaces and warned that “state Insurance Commissioner Mike Chaney continues searching for sneaky loopholes to implement a health care exchange – undermining Mississippi’s elected officials and ignoring the will of the people in his state who clearly oppose Obamacare.”

Meanwhile, with nearly half of Mississippi’s counties likely to be without an insurer to turn to on Oct. 1, residents in the counties could find themselves penalized by the IRS in 2015 for not having mandatory health insurance coverage in 2014.

“That’s a question that is being asked,” an Insurance Department official said.



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