Courtesy of our Compass friend Eric Axel, I was forwarded an awesome article from the magazine Politico entitled, “Mississippi, Burned.”
The article by Sarah Varney describes how Obamacare was (or rather was not) implemented in Mississippi and that lack of implementation affected the state. The article rather long (in a good way), but well worth the read if you want to make the time.
I will try to briefly summarize:
Mississippi had initially intended to put in place an ‘insurance exchange’ so that small employers could band together and purchase health insurance for their employees—even before Obamacare was put in place. It was a ‘conservative’ effort spearheaded by a Republican governor and a Republican state insurance commissioner. However, a new, governor came into office around when Obamacare was put into place and put a stop to the exchange for small employer or any other state-based exchange for individuals. Mississippi decision makers wanted nothing to do with Obamacare.
The prior insurance commissioner remained and did everything he could to at least get some insurance carriers to participate in the Federal Exchange that would go into place in Mississippi. He got 2: Humana and another small insurance carrier. Blue Cross of Mississippi would not even participate. So—very few insurance choices.
On top of that, Mississippi did very little to try to obtain money for ‘navigators’ to help the public sign up for the exchange or promote the exchange with advertisements. The result—by December 2013, only 802 people had signed up for Obamacare. The number did grow somewhat over the subsequent months, but the damage was already done.
THE UNINTENDED CONSEQUENCE:
Obamacare reduces payments to hospitals that are often referred to as ‘safety net’ hospitals. The thought being, these hospitals will more than make up for the cut in funding by having fewer uninsured patients to treat (i.e. more insured, paying patients who signed up for Obamacare). Well in Mississippi, the funding was reduced, but the rolls of uninsured patients did not go down. As a result, hospitals that were already barely scraping by were forced to make even more cuts.
The article tells of Montfort Jones Memorial Hospital that was forced to close its ICU permanently due to lack of funding. With no ICU in the rural town of Kosciusko, MS, patients literally have to be put in an ambulance and driven 70 miles to Jackson, MS if they need critical care for things like heart attacks, strokes and severe infections.
I am not trying to make overall value judgments on Obamacare—it certainly has helped many people as well—but rather I want to point out that policies have Unintended Consequences. This is not a new thought, but it is important to keep in mind. Unintended consequences happened in Federal policy, but they also happen in corporate policies and employee benefits policies. If you are an employee benefits professional, you put in place policies all the time—policies that govern what your plan does or does not cover; whether to do a spousal audit; whether to put in place a wellness or tobacco surcharge; whether to put in place step therapy, etc.
All those policy decisions have unintended consequences. Now, that should not preclude you from putting thoughtful policies in place, but rather to realize you are always going to cause some things to happen that you never intended to happen. So we all need to keep our eyes open for these unintended consequences and adjust our policies to improve the results.
No solution is perfect, but we owe it to employees and their families to work to constantly improve our health plan policies to achieve the best results. Thank you, Politico, for opening our eyes to this dynamic in Mississippi.
To see how Compass works with employers and employees to minimize unintended consequences, click on the < 2 min whiteboard video below: