When the U.S. Supreme Court announces its ruling on the legality of federal subsides for Americans who enrolled for health care through the federal health care marketplace, the decision could have a direct impact on roughly 100,000 Mississippians and an indirect impact on everyone else, a state official and a leading Mississippi healthcare advocate agree.
Last week, the Supreme Court heard arguments in King v. Burwell, a case that challenges whether federal subsidies in 34 states — including Mississippi — that have not set up their own health insurance markets — also known as exchanges — are legal under the Patient Protection and Affordable Care Act (ACA).
The plaintiffs argue a particular section of the law refers only to “exchanges established by the state” when mentioning eligibility for subsidies – meaning it explicitly excludes marketplaces established by the federal government. The government is arguing that the phrasing may be unfortunate, but the entire law clearly intends the federal tax credits apply to people using the federally established exchange, not just the state ones.
Mississippi Insurance Commissioner Mike Chaney said if the court rules that the subsidies are illegal, a high percentage of Mississippians who have signed up for the ACA could find themselves without health insurance.
As of February, Chaney said 103,000 Mississippians had signed up for coverage through the federal health care marketplace. Another 80,000 have been added to the state’s Medicaid roles in the past year.
Jarvis Dortch, a program manager with the Mississippi Health Advocacy Program, said almost all of that latter group are children whose parents discovered they were eligible for Medicaid as they were trying to access the ACA.
While the uninsured rate nationally has dropped steadily since the ACA rollout in October 2013 — it now stands at less than 14 percent — only 1-in-3 uninsured Mississippians have insurance today, Chaney said.
In Lowndes County, 1,076 people have signed up for the ACA, while 1,095 enrolled in Clay County. In Oktibbeha County, however, just 126 people signed up for the ACA.
“I can’t tell you specifically what has happened in Oktibbeha County, but what we have discovered is some counties have done a much better job of getting the word out and reaching out to people than others. I suspect that might be the case there,” Dortch said.
Work to be done
Chaney said many Mississippians remain without health insurance.
“There are still about 300,000 people, at a minimum, that need help,” he said.
And for those who did sign up for healthcare through the federal exchange, the Supreme Court’s decision could have a great impact.
“I’d say anywhere from 85 to 90 percent of the people who have signed up got subsidies,” Chaney said. “So if the Supreme Court rules that the subsidies are illegal, that could be a major problem.”
While Chaney offered no opinion about what the court’s ruling would be, he said he has already started making plans.
“I think if the Supreme Court did rule against the subsidies, it probably wouldn’t go into effect until the first on next year,” Chaney said. “If that happens, we’ve put together an contingency plan, but that would require approval by the governor and the legislative leaders because it would require some funding other than from the state. It’s very expensive to put into place.”
In February 2013, Chaney had put together a state insurance marketplace, only to have it rejected by Bryant. Had Chaney’s marketplace had been allowed to stay in place, the Supreme Court’s ruling would not have had an immediate impact on subsidies offered for enrollees.
“When people ask me about that, I just say my job is to look ahead, not back, but yeah, we might have found ourselves in a better situation if the governor had allowed us to put that state exchange into place. It would have meant more carriers, and that competition generally means lower prices.”
While roughly 100,000 Mississippians could be directly affected should the Supreme Court rule the subsidies illegal, Dortch said the ruling could have an impact on even those people whose insurance did not come through the ACA.
“Your talking about millions of customers that the insurance companies would lose if that happens,” Dortch said. “Well, they’re going to have to make up for that somewhere, and I suspect that would mean higher premiums for everybody; I’ve heard as much as a 47-percent increase. I’m not sure it would go that high, but there’s every reason to expect that premiums would go up. It’s basic math.”
Slim Smith is a columnist and feature writer for The Dispatch. His email address is email@example.com.