Mississippi is no closer to creating a state-run health insurance marketplace than it was two years ago, when lawmakers first granted the insurance commissioner the authority to do so, according to a state official.
The Mississippi Senate on March 3 rejected a House proposal to require the commissioner to create a state-run health insurance marketplace by revising the law’s wording from “may” to “shall.” This slight wording adjustment would have shifted the commissioner’s option into a mandate.
J. Walter Michel, a Republican from Ridgeland and chairman of the Senate Insurance Committee, said he chose not to bring the bill up for consideration — effectively killing the legislation — because Insurance Commissioner Mike Chaney does not support it. Chaney has repeatedly said he does not plan to create a state exchange to offer health insurance to Mississippians unless Gov. Tate Reeves signs off on it.
Chaney told Mississippi Today he still lacks the governor’s approval to move forward with establishing the exchange, adding that the bill does little to develop a state-based marketplace.
“It’s much to do about nothing,” Chaney said. “We already had the authority.”
Chaney aimed to create a state-run exchange in the years after the Affordable Care Act was passed, but former Gov. Phil Bryant opposed the plan and blocked the effort.
Gov. Tate Reeves did not respond to a request for comment about whether he supports the creation of a state-based exchange.
State Affairs Chairman Rep. Hank Zuber, a Republican from Ocean Springs and the author of the House’s bill, said on the House floor Feb. 12 that the creation of a state-based exchange could have wide-reaching impacts.
“We’re going to help our employers provide insurance for our hardworking citizens,” said Zuber. “We’re going to bring down medical costs, and we’re going to increase the number of insured in Mississippi.”
But experts say whether a state-run marketplace lowers insurance costs or increases the number of people with coverage largely depends on how much a state invests in the program.
States with state-based exchanges generally have lower uninsurance rates, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. But, she said, that is largely a result of states supplementing federal subsidies and strengthening their exchanges by improving customer enrollment assistance, marketing and IT infrastructure.
“It very much depends on what the state’s vision is for the exchange and how much they are able to invest in terms of helping people enroll and stay covered,” Corlette said.
Zuber said he does not know how a Mississippi state-based exchange would be structured, but said he did not envision the state offering additional subsidies on top of those provided by the federal government. He said lawmakers would study the possibility of creating a state-based exchange.
“We’re going to probably look at it this session, this summer, and maybe even into next session,” he said. “We’re going to see if it’s the right thing to do.”
Even if the governor supported creating a state-based exchange, Chaney said it would be less beneficial now than in previous years, because the federal subsidies that made health insurance more affordable for millions of Americans expired at the end of last year. As a result, fewer people are enrolling in Affordable Care Act plans, which would reduce potential revenue if the state were to operate its own exchange.
“It might be too little, too late, because the dollars are not there that would have been there before,” Chaney said. “The subsidies are gone.”
Early data has shown a downswing in enrollment on the health insurance marketplace in Mississippi for 2026. About 25,000 fewer Mississippians enrolled in Marketplace plans compared to last year. Experts say they expect enrollments to fall even further, because people may disenroll from coverage when they receive their first bill reflecting a higher monthly premium.
The expiration of the subsidies, which in turn has led to falling Marketplace enrollment, has made state-run exchanges less financially sustainable for states, Corlette said.
“It’s kind of become a real ‘crunching the numbers’ challenge for states to make their exchanges viable from a financial perspective,” she said.
Mississippi currently operates its exchange on the federal platform, like 27 other states.
Health insurance marketplaces — whether they are run by the state or the federal government — are funded by user fees paid by insurance companies. These costs are passed on to consumers in their monthly insurance premiums.
State-run exchanges bring in revenue for the state. That funding is generally used to support the operation of the exchange and gives states greater flexibility and independence in managing their program. But running an exchange is also a significant responsibility, as states must certify which health plans are sold, operate the exchange and manage consumer assistance programs, said Jason Levitis, a senior fellow at the Urban Institute.
Khaylah Scott, a program manager for the Mississippi Health Advocacy Program, said she believes an effective state-based exchange would allow the state to tailor the program to the needs of Mississippians and provide additional subsidies to consumers, which would make the program more efficient and lower health insurance costs.
Chaney said the state has about $20 million in funds held by the Comprehensive Health Insurance Risk Pool Association, a reserve accumulated from the state’s former high-risk insurance plan that was no longer needed after the passage of the Affordable Care Act, that could be used to create a state-based exchange. He estimated that it would take between $15 million and $20 million to get a state-run exchange up and running. Once operational, a state-based exchange would pay for itself with user fees.
However, Chaney said the user fees would not generate a significant amount of revenue due to the number of people enrolled in insurance through the marketplace in Mississippi.
“It’s not a lot of money,” he said. “It’s a lot of headache to try to make $20 (million) or $30 million.”
Chaney said it is possible that a state-based exchange would increase insurance rates, but it is unlikely the changes would be significant.
Recently proposed federal changes would make transitioning to a state-based exchange easier for states, said Levitis.
One proposed change would allow state-based exchanges to use private web brokers to operate the website that facilitate eligibility determinations and enrollment. Another proposal would eliminate the previously required one-year period during which states had to operate a state-based exchange on the federal platform before fully transitioning to their own platform.
Scott said the proposed changes could present drawbacks, including reduced federal oversight. She added that she supports waiting to see how federal changes shake out before moving forward with a state-based exchange.
Some of the federal changes may also create opportunities for states to expand programs that have been scaled back by the federal government, said Levitis.
The Centers for Medicare and Medicaid Services announced in February a 90% reduction in funding for a program that helps people enroll in the federal marketplace. In a press release, the agency said it would instead focus on reducing user fees, which would translate to lower premiums for customers.
States that want to boost coverage rates through outreach efforts could choose to step in and expand those activities, Levitis said.
Scott said she believes it is best for Mississippi to have a clear vision and goals before pursuing a state-run exchange.
“We need to get our feet underneath us before we consider something of this scale,” she said.
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