Two states, different experiences under health care law

Mississippi sees few signups, high prices but that's not so in Kentucky.

JACKSON, Miss. - For a 50-year-old nonsmoker in Mississippi's most populous county, the least expensive health plan in the federal insurance marketplace costs $385 a month, nearly 40% higher than its equivalent in Kentucky.

There, the same person can find a mid-range, or Silver plan, for as little as $278 a month. The annual savings between those two plans could purchase a new Apple MacBook Pro laptop, for example, or six weeks of groceries for the average family of four. And Kentucky's median household income last year was already nearly $4,500 higher than Mississippi's: $41,086 vs. $36,641.

STORY: How law is playing out in 3 key statesSTORY: Sticker shock hits exchange shoppers

The reason for the better insurance rates? Kentucky is the only state in the Southeast running its own health care marketplace. It has some of the region's least expensive plans, a Clarion-Ledger comparison found.

'We would have been a whole lot better off' with a state-based exchange, said Mississippi Insurance Commissioner Mike Chaney, who had led efforts to start one but ran into opposition from Gov. Phil Bryant.

It also boasts the nation's highest applicant rate and the third-highest enrollment rate, according to data from U.S. Department of Health and Human Services and the Henry J. Kaiser Family Foundation. More than a quarter of potential beneficiaries applied for coverage within the first month.

More than 5,500 Kentucky residents so far purchased coverage through Kynect, the name of its state-run exchange.

Mississippi, which relies on the troubled federal marketplace website, has the nation's lowest enrollment rate. Less than 0.1% of the state's estimated beneficiaries - 148 people - signed up for a plan the first month.

Almost 300,000 Mississippi residents should be enrolling through the website, the Henry J. Kaiser Family Foundation says.

The Magnolia State had an independent website that operated for about four months and sold several hundred policies, Chaney said. But Bryant's opposition prompted the federal government's rejection of the system in February, and that forced Mississippi to use the glitch-prone federal website.

^'I have been a supporter of ACA and have been waiting to finally get health insurance only to find out it is still basically unavailable (because of the price). ^'

- Leah Smith Headings, Tupelo, Miss.

Nearly two months after the launch of that website, many residents say they still can't access information, much less enroll. Those who have gained access say they're dismayed by plan costs and don't want to sign up.

'I have been a supporter of ACA (the federal Affordable Care Act) and have been waiting to finally get health insurance only to find out it is still basically unavailable,' said Leah Smith Headings, a self-employed family counselor in Tupelo, Miss.

Headings said she hasn't had health insurance for years, but the cheapest plan she found cost more than $600 a month with a $4,000 deductible and no co-payments. Once the benefits kick in, she said it still would pay only 40% of her medical bills.

She isn't eligible for tax credits.

'I am very disheartened and disappointed,' she said.

In Kentucky, Henrietta Dean of Louisville had been putting off thyroid surgery to stop a disease that is leaching calcium from her bones because she had no insurance. But in October she was able to sign up for expanded Medicaid coverage, another product of the Affordable Care Act.

'I'll be able to go to the doctor, ... to my specialist,' said Dean, 59, whose family income is about $18,000 a year. 'I believe it's going to take a lot of people out of bondage that (are) in pain and ... don't go to the doctor because they can't afford it.'

Unlike Kentucky, where three insurers offer a multitude of plans through the marketplace, Mississippi was able to attract just two carriers - Humana Health Insurance Co. and Magnolia Health Plan.

That's because of the state's overall poor health and high poverty as well as Blue Cross & Blue Shield of Mississippi's intimidating 81% of the market share. But Chaney also blames the loss of a state-run exchange.

Samantha Davis, left, a Kynect certified application counselor, helps Henrietta Dean of Louisville, Ky., through the screening process and talks with her Oct. 15, 2013, about her eligibility for different health care options at Family Health Centers - Portland.(Photo: Angela Shoemaker, The (Louisville, Ky.) Courier-Journal)

'We had at least three other carriers that were interested in selling on the state-based exchange,' he said. 'But they pulled out after CCIO denied our state-based application.' CCIIO stands for the Center for Consumer Information and Insurance Oversight, a division of the U.S. Department of Health and Human Services.

Chaney has acknowledged Humana and Magnolia's rates hover above that which most residents are accustomed but attributed that to Affordable Care Act mandates. He also noted that they're in line with what they offer nationwide.

Another problem: 'The ability to reach people who don't have insurance is limited,' Chaney said.

The federal government gave the state Insurance Commission less than $370,000 to reach and educate consumers about the marketplace vs. the $3.5 million federal grant available had it operated a state-based exchange.

The paltry dollar figure doesn't include more than $3.3 million in federal money awarded to Mississippi organizations and health centers for outreach and assistance, according to Enroll America, a national nonprofit pushing for maximum health care coverage under the new law.

One of the federal grant recipients, the University of Mississippi Medical Center, has helped more than 11,000 residents across the state since Oct. 1, according to spokesman Matt Westerfield.

Many of them simply seek a basic understanding of the Affordable Care Act and how it applies to them, said Conner Reeves, the medical center's Navigator Initiative project manager .

'They want to know more, if what they're hearing on the news is true, if they can access the marketplace,' Reeves said. 'For one consumer it works; for another it doesn't.'

Contributing: Laura Unger, The (Louisville, Ky.) Courier-Journal

For Julie Holcomb, 53, of Tupelo, Miss., the website hasn't worked since Day 1. The real-estate agent estimates she has spent eight hours combined in the past seven weeks trying to obtain insurance.

Each attempt ended in error messages and frustration, an inconvenience for any consumer but potentially life threatening for Holcomb.

The liver transplant survivor will lose her federal, pre-existing health insurance coverage Dec. 31 because of the Affordable Care Act. If she fails to obtain a similar plan, she'll face out-of-pocket costs on $2,000 worth of monthly medications that prevent organ rejection.

'I just got another letter today informing me for the third time that my policy will be canceled Dec. 31,' Holcomb said. 'But I have no idea what kind of plans are available (through the marketplace) or how much they will cost because it wouldn't even let me get to that part of the website.'