- State-based health insurance exchange, state employee HSAs among measures passed this session, while reforms that would have increased medical providers died.
While talks of Medicaid expansion took much of the air out of the state Capitol over the last four months, other reforms were proposed to aid in the delivery of healthcare to Mississippians.
Here is a brief look at some of those proposals and where those bills ended up when lawmakers gaveled out for the year.
Establishment of a State-Based Insurance Exchange
House Ways and Means Chairman Trey Lamar (R) authored HB 1647 which creates a state-based exchange, or marketplace, for health insurance. The legislation was sent to conference and agreed to with only 12 dissenting votes between the House and Senate.
If signed into law by Governor Tate Reeves (R), Mississippi would move away from the federal exchange established through the Affordable Care Act and create a state exchange.
The legislation as originally proposed offered a web of tax credits and tax deductions aimed at increasing health insurance companies participation on the state exchange. Lamar at the time explained, “what we’re trying to do is incentivize more insurance companies to participate and to offer better policies for the people that fall within those categories that could benefit from it.”
However, in the final version sent to the Governor, those tax incentives were stripped from the bill. Still, Mississippi Insurance Commissioner Mike Chaney (R) said the legislation could lower the cost of insurance for people who buy on the state exchange if properly run.
The Department of Insurance would be authorized to establish and operate the state exchange. The legislation would create a Mississippi Health Insurance State Exchange Trust Fund to operate the marketplace, the revenue of which would come from fees assessed on the gross premiums charged on all policies sold on the exchange. That fee is not to exceed 3.5%.
Commissioner Chaney (R) previously said the shift away from the federal exchange would largely benefit individuals earning between the 100 and 138 percent of the federal poverty level (FPL) but the state-based exchange would likely not be up and running until 2025. Mississippians earning between 100 and 138 percent of the FPL presently have access to $0 premium, $0 deductible, and $0 co-pay insurance that is fully-subsidized by the federal government on the ACA exchange.
The bill is set to be returned by the Governor on May 13.
Exempting Non-Profit Agricultural Membership Organizations
Mississippi became one of seven states to pass legislation that exempts non-profit agricultural membership organizations from regulation as insurance. The measure received unanimous approval in both chambers.
The bill, authored by State Senator Walter Michel (R), allows such organizations to provide healthcare benefits or services under a self-funded arrangement administered by an entity that holds a certificate of authority as a third-party administrator in the state.
“The application for coverage of any healthcare benefits or services provided pursuant to this section must prominently state that the healthcare benefits or services plan providing such coverage is not insurance, is not provided by an insurance company, is not subject to the laws and rules governing insurance, and is not subject to the jurisdiction of the State Insurance Department or the Commissioner of Insurance,” the legislation outlines.
According to Starla Brown, State Director for Americans for Prosperity (AFP), SB 2851 is ultimately about affordability.
“These nonprofit membership plans can be significantly more affordable than traditional health insurance because they are mutual aid rather than insurance,” Brown said. “These health plans are more affordable than traditional insurance because they can be exempted by a state legislature from both state and federal insurance regulations.”
Governor Reeves signed the bill into law on April 17. It is set to go into effect as of July 1.
State Employee Health Savings Accounts
SB 2125, signed into law by Governor Reeves on April 19, requires the State and School Employees Health Insurance Management Board offer all state employees access to health savings account (HSA).
The legislation, authored by State Senate Chris Johnson (R), notes that the employee who seeks an HSA would be required to pay the full cost of the program and consent to a payroll deduction.
HSAs are tax-advantaged savings accounts for medical expenses, similar to a 401(k). The money invested in an HSA isn’t taxed so long as it is used for a qualified medical expense.
“This tax advantage essentially gives HSA holders up to a 37% discount (depending on the holder’s tax bracket) on each out-of-pocket health care purchase,” AFP’s Brown said. “However, HSAs are only available to people with a federally defined high-deductible health insurance plan — just 10% of Americans.”
State and school employees in Mississippi should be able to opt in for an HSA soon after July 1, when the legislation takes effect.
CON Reforms Die Once Again
Reforms to certificate of Need (CON) laws have been a hot topic among think tanks and other groups outside of the healthcare bubble, with the focus being to find less restrictive, more competitive ways to elevate and expand healthcare access in Mississippi.
CON laws, initially aimed at preventing the duplication of services and control costs within an area, are now viewed as largely outdated, protectionist even, by many onlookers seeking solutions with affordability, quality, and accessibility in mind. These regulations prevent a medical provider from opening a new location or offering new services without first obtaining permission from the state.
Two bills – HB 419 and HB 848 – that could have brought CON law reforms to the forefront both died in the 2024 session.
Douglas Carswell, the CEO of the Mississippi Center for Public Policy, was disappointed to see the measures taken off the table.
“The former would have removed restrictions that intentionally limit the number of healthcare providers. The latter would have removed Certificate of Need restrictions limiting the number and range of psychiatric service providers,” Carswell said. “Both proposals were killed off. This is especially disappointing given the powerful testimony to the House during evidence sessions which showed that these restrictions serve the interests of a few healthcare corporations, not the patients.”
HB 419, authored by State Rep. Hank Zuber (R), would have brought forward code sections related to CON laws, inserting a repealer for June 30, essentially providing a vehicle for lawmakers to debate and consider changes to the CON laws on the books. While it passed the House 112-5 after being double referred to the House Public Health and Human Services Committee and the House State Affairs Committee, the measure was not well received in the Senate, where it died in the Senate Public Health and Welfare Committee.
As for HB 848, authored by State Rep. Lee Yancey (R), the legislation directly addressed CON regulations on chemical dependency service and facilities, affiliated care facilities, facilities for individuals with intellectual disabilities, psychiatric residential treatment facilities, and birthing centers.
Rep. Yancey previously said the legislation was modeled on recommendations from the Mississippi State Department of Health, that agency that oversees CON application approval, with input from the Department of Mental Health.
The measure made its way into conference after unanimously passing in the House and with only one dissenting vote after being amended in the Senate. Yet, conferees failed to reach an agreement, allowing the bill to die on deadline.
Advanced Practice Nurses No Closer to Full Practice Authority
For the last several years, legislation has been introduced that would allow experienced advanced practice nurses, like nurse practitioners, to provide basic medical care without a supervision agreement with a treating physician. State Senator Kevin Blackwell (R) proposed the legislation this year through SB 2079, but the bill did not receive a hearing or vote.
Supporters of the legislation point to twenty-seven states that have implemented the reform and studies which have shown that allowing full practice authority increases the supply of medical providers, particularly in underserved areas, while also improving health outcomes and lower costs.
Opponents argue that eliminating supervising agreements is unsafe for patients.
Under current Mississippi law, advanced practice nurses can already provide medical care within the scope of their training without a physician present. Instead, advanced practice nurses pay a physician to review 10% of their charts once a month after patients have already been treated.
