Building Mississippi's health insurance exchange

Background: Mississippians aged 19-64 years old have a 24% rate of uninsurance, a significantly (p<.01) higher figure compared with 21% of Americans in the same age group who are uninsured. In March 2011, proposed legislation to create a "Health Benefit Exchange" failed to pass. In May of that year, the Mississippi Comprehensive Health Insurance Risk Pool Association amended its bylaws to establish and administer Mississippi's Exchange. Mississippi has received more than $21 million in planning and establishment grants from the federal government, and is moving forward to establish a state-based Health Insurance Exchange by the Affordable Care Act (ACA) deadline of January 1, 2014. Methods: Systematic literature review of both state and federal level current regulations, laws, and actions related to the ACA, specifically the establishment of Health Insurance Exchanges. Results: Once the Affordable Care Act (ACA) is fully implemented, approximately 275,000 Mississippians are projected to enroll in health insurance coverage through an Exchange. Of this number, an estimated 229,000 Mississippians should be eligible for subsidized coverage through premium tax credits administered by the federal government. Discussion: Mississippi is a politically conservative state with limited managed care, limited insurance market variability, and a high rate of uninsured citizens. There is a well-established body of research that indicates insurance coverage leads to improved population health. Some factors that will determine if Mississippi's Exchange is successful include what efforts are made to address consumer outreach and education, with particular attention paid to limited health literacy and low levels of Internet use.