Yes, but only through the kindness of strangers. Thanks, federalism!

By one count, Mississippi’s Obamacare (née Patient Protection and Affordable Care Act of 2010) marketplace will charge the third-highest premiums in the country. By another, Mississippi’s premiums will be among the lowest. Not surprisingly, Republicans prefer to cite the former, while Democrats trumpet the latter.

Who’s correct? Both, technically. But by the statistic you should care about — how much will come out of your pocket — Mississippians are actually getting a pretty sweet deal.

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That’s all thanks to the federal tax credits available to uninsured middle- and working-class Mississippians (up to 400% of the federal poverty line, i.e. $45,960 for individuals and $94,200 for a family of four). Most of Mississippi’s uninsured population falls under this threshold. Of the 275,000 Mississippians expected to enroll in the marketplace, or “exchange,” 229,000 will likely qualify for tax credits.

[/column] [column size=”one-half” last=”true”][alert type=”info”]Read the Department of Health and Human Services’ report for full premium estimates.

For more information about healthcare reform in Mississippi, check out the Center for Mississippi Health Policy.[/alert][/column]

Many now-uninsured Mississippians will be able to buy a basic health coverage for less than the cost of high-speed internet. After the subsidy, a family of four making $50,000 a year can purchase a “Bronze” plan covering essential benefits plus 60% of out-of-pocket expenses for as low as $28 a month. A 27-year-old making $25,000 can get a Bronze plan for $75 a month. The mid-range Silver plans will cost a monthly average of $282 for the family and $145 for the 27-year-old. No matter the plan, Obamacare’s minimum coverage standards and ban on insurance abuses will ensure that hundreds of thousands of Mississippians gain the medical and economic security than they cannot currently afford.

Republicans prefer to cite the pre-subsidy cost of insurance, which falls on only about 17% of those seeking insurance on the exchange. Low competition, expensive medical needs, and a large rural population conspire to produce a whopping sticker price: the average Silver plan will cost $448 a month, or $1,069 for a family of four.

Depending on age and health, some of those folks probably could have gotten cheaper insurance before Obamacare. Many, especially those in their 50s and 60s with preexisting conditions, could not.

Insurers have traditionally accounted for high costs by a) sifting out expensive patients and only offering coverage to the cheap ones, or b) charging premiums higher than many could pay. Often they did a combination of both, which is why 20% of Mississippians will go without insurance until Obamacare’s January 1 start date. After the full implementation of the law — including the Medicaid expansion, which we can’t reject forever — only 7% will remain uninsured.

[toggle title=”Where will Mississippians get their insurance after Obamacare? “]ACA Changes[/toggle]

Even so, insurance companies aren’t thrilled about covering wheezing, obese, diabetic Mississippi. Only two insurance providers, Humana and Magnolia Health, agreed to participate in the state’s exchange (the national average is eight). To make matters worse, they will only compete directly in the state’s four largest counties — Hinds, Rankin, Madison, and DeSoto. Residents in the remaining 78 counties can pick their plan, but not their provider.

With or without Obamcare, the cost of insuring Mississippians is really, really high. Luckily, our healthier, wealthier compatriots have volunteered to bear most of that cost — not that our leaders have taken the time to thank them. It’s a time-honored Mississippi tradition to bash the federal government while cashing its checks. Obamacare is just another example. Despite being opposed by all but one member of our Congressional delegation, Mississippi will take in much more in health subsidies (an estimated $912 million in 2014) than we pay out to the rest of the country. That’s even after state leaders spitefully refused billions in extra Medicaid funding.

For all of the bluster about Obamacare raising Mississippians’ premiums, the law’s opponents are actually making a strong case for more federal intervention in our state’s healthcare system. Mississippi simply has too little money and too many health liabilities for a state-based solution to bring down rates for everyone.

The only way to make Mississippi’s private insurance affordable is to pool our sick and poor are with healthier, wealthier citizens of other states. At the very least, the federal government must exercise strong regulatory control over coverage and pricing, then subsidize its purchase among low-income citizens. That, in effect, is what Obamacare does, and it makes far greater strides toward accessibility than any of its opponents’ alternatives would.

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