Mississippi's Insurance Department will likely be running the small business portion of the otherwise federally-managed insurance exchange serving state residents -- even as the insurance commissioner and other state officials make it clear they're not fond of the rest of the Affordable Care Act.
"Mississippi is in a position to begin operation of a free market SHOP marketplace in the first quarter of 2014," Mississippi Commissioner of Insurance Mike Chaney said in a media release announcing the plan to operate the Small Business Health Options Program, or SHOP.
Earlier this year, Chaney, a Republican from Vicksburg who served as a state legislator for 15 years before being elected to insurance commissioner, lobbied the U.S. Department of Health and Human Services for permission to run the entire insurance exchange for Mississippi, even as Governor Phil Bryant balked at the idea.
HHS decided exchange operations couldn't be handed off to Chaney's agency without the governor's or legislature's approval. But now, HHS seems set to allow state management of only the small business program -- and Chaney is pitching the HIX's SHOP as "not an ObamaCare state exchange for subsidized beneficiaries" and a program that "does not expand Medicaid."
In late August, HHS regulators at the Center for Consumer Information and Insurance Oversight published rules paving the way for state governments to operate small business exchange programs even if the individual market remains federally-run.
That framework partly evolved from the unique case of Utah, which created a small business-only insurance exchange before the ACA was passed. Under a state-federal partnership agreement reached earlier this summer, Utah will operate the small business HIX, called AvenueH, while HHS will manage an individual market, where individuals not offered affordable workplace insurance will be buying subsidized health plans.
In Mississippi, it's not entirely clear how many insurers will end up selling either individual or small group products. Until late July, when Humana stepped in, no insurer was planning to sell individual exchange policies to consumers in 36 of Mississippi's 82 counties. Now, Humana and Centene's Magnolia Health Plan will largely cover the state, so that Mississippians will have at least one individual health plan option through the exchange.
Chaney said he helped persuade Humana to expand beyond its initial four urban areas and that three insurers have expressed in selling SHOP plans, and possibly other insurers too.
How Mississippi's SHOP HIX program will be financed also remains unclear. A health plan fee of two to five percent has been considered, and Chaney estimates the state would need about $1 million annually. He's meeting with HHS officials later this month to work out details.