Politics & income, not technology, could impede Mississippi’s ACA outreach

New America Media

Khalil Abdullah
Jackson, MS – While much of the scrutiny of the Affordable Care Act has been focused on the technical glitches of the October launch of the healthcare.gov website, Cover Mississippi, an amalgam of non-profit and private interests, has been working to reach state residents, including those for whom Internet access is uncommon, impractical, or too expensive.

“Never in my 10 years of working on behalf of children and child advocacy have I seen such a unique coalition be put together,” said Kim Robinson, Program Manager of the Jackson-based Southern Regional Office, Children’s Defense Fund. “It’s a statewide campaign that is needed for education and outreach to the most vulnerable citizens.”

Robinson, speaking as a panelist to a forum for media convened by New America Media to assess the challenges of disseminating information about the ACA to Mississippians, was joined by representatives from Humana and Magnolia, the two private insurers that have signed on to be providers for the Mississippi’s Health Insurance Exchange; Tinneciaa Harris, Project Administrator, University of Mississippi Medical Center, one of the two recipients of the state’s navigator grants; and Linda Dixon Rigsby, Health Law Director, Mississippi Center for Justice.

Though Mississippi declined to build its own exchange, leaving that task to the federal government, it nevertheless has forged ahead with Cover Mississippi as a strategic plan that includes each of the panelists’ organizations in addition to Oak Hill Missionary Baptist Church Ministries, Inc., the other navigator grant recipient; as well as consumer assistance programs and federally qualified health centers which often service low income, uninsured, and immigrant populations.

One objective of the coalition is to drive Internet traffic to the exchange website where Mississippians can compare policies and then purchase insurance. Often referred to as the individual mandate, the requirement for most individuals to have health care insurance – or to be fined a fee or percentage of their income—was an aspect of the ACA upheld by the Supreme Court. The ACA does not require that an insurance policy be purchased on the exchange, but as other panelists and Stacey Carter, Humana Market Director, Mississippi, stressed, “in order to get a subsidy, you have to go through the exchange.”

The size of the subsidy, for those eligible, varies depending on a number of factors, but the Mississippi Health Exchange estimates that over half a million of the state’s uninsured are subsidy-eligible, with over 67 percent having a full-time worker in the family. The numerical break down also projects that the uninsured subsidy-eligible population is almost evenly divided between European and African American residents, at 48 and 47 percent respectively, while three percent are Latinos and one percent are Asian or Pacific Islanders.

Collectively, the panelists described ambitious plans to cast a wide net in efforts to reach the public and potential allies who can help disseminate accurate information. Carter spoke about Humana’s presence at the state fair and at the recent Mississippi Nurses Association Convention in Biloxi on the Gulf Coast. She said the November rollout of two mobile units will help Humana cover “every mile of the 40 counties” in which they ‘re doing business, including outreach to churches on Sunday after service, shopping malls, Walmarts, CVS stores, YMCAs, and even “local gas stations where people stop by. We have a lot of boots on the ground,” she said.

Similarly, Mary Anna McDonnieal, Manager of Marketing and Communications, Magnolia Health Plan, explained that her company, promoting ACA enrollment through ambetter., a health insurance company, active in 46 counties, “has been doing outreach for three years. We’ve established a great resource of faith-based organizations, advocacy groups, non-profits, community leaders, and chambers of commerce. We know a lot of small business – and a lot of businesses out there – where employees are going to need to know about this also.”

McDonnieal said Magnolia has staffed a call center with 42 licensed insurance agents who are especially trained to assist individuals who do not have Internet access but who can get to a phone. Several panelists noted that a common misconception is that a person has to have a computer to get eligibility status from the exchange. The key, they explained, is for Mississippians to get their qualifying information – whether through a paper application or a phone call – into the hands of someone who can then access the exchange on their behalf. The applicant will then subsequently be contacted by mail or phone as to whether he or she can or cannot receive a subsidy and the prices of the policies available to them.

Clearly, access to the Internet is of concern to Nancy Stewart, Director of Operations, Jackson Hinds Comprehensive Health Center. Even with an aggressive marketing campaign like Cover Mississippi, reaching across the breadth of the state into smaller rural communities with negligible infrastructure will be challenging. “Even if it was working,” said, referring to the Mississippi Health Insurance Exchange, “it might not work here. Our people don’t have the technology; some don’t even have libraries and staff to go to do this and they definitely don’t have it at home. They can’t afford food. You know they don’t have the technology at home to sign on-line.”

Communities without a major hospital nearby, for example, cannot reap the benefits of an institution like Jackson’s University of Mississippi Medical Center that, according to Tinniceaa Harris, has trained 41 navigators to assist potential enrollees. Though UMMC’s initial ACA educational effort was to tap consumers as they came through the hospital’s doors, its goal to take the message of ACA benefits into communities is more ambitious. Harris noted that UMMC has partnered with the Mississippi State Department of Health and is working Mississippi State University Extension Services and the Mississippi Hospital Association to broaden the footprint of navigators and raise public awareness throughout the state.

Rigsby, Mississippi Center for Justice, emphasized the urgency of the public education effort as it relates to children, given that Mississippi remains one of the 26 states that chose to refuse the federal offer to raise the ceiling of income eligibility to 138 percent of the Federal Poverty Level for its Medicaid population. An estimated 300,000 Mississippians could likely have received insurance through Medicaid, according to Rigsby, had the state embraced that opportunity from 2014 through 2016 to have 100 percent of the costs borne by the federal government; no less than 90 percent in years moving forward.

“These are hardworking Mississippians, store clerks, cashiers, and construction workers,” she explained, using those occupations where a coverage gap exists for workers who often have salaries “where they make too much to qualify for the current Medicaid program and not enough for them to purchase insurance on the exchange.”

“Expanded Medicaid will help Mississippi have a healthier workforce, in addition to bringing 9,000 jobs into the state,” Rigsby contended. She said it was important to continue to press the state’s legislature and governor to bring more adults into health insurance coverage network because “when parents have health coverage, children are likely to be covered as well.”