Bobby Harrison: Rising insurance exchange costs bad for working poor

Mississippi had one of the nation's largest declines in the Affordable Care Act health insurance exchange enrollment based on early 2026 numbers, meaning that it has become even more difficult for the state's working poor to garner medical care.

According to The Associated Press, Mississippi's ACA health insurance exchange enrollment declined 26.4% from February 2025 to February 2026. It is likely that the enrollment will drop even more – perhaps significantly more – because of the higher cost to obtain a policy from the health insurance exchange based on decisions made by the administration of President Donald Trump.

It could be logically argued that the higher costs of the insurance policies obtained on the exchange impact Mississippi's working poor more than any other group in the country. First of all, Mississippi's working poor population is behind the proverbial health care eight ball because the state is one of 10 nationwide that has not expanded Medicaid, as is allowed under the Affordable Care Act with the federal government paying the bulk of the costs.

In the 40 states that have expanded Medicaid, many of their low income people do not have to depend on the health care exchange for coverage. They can sign up for expanded Medicaid to obtain health care. But in Mississippi, Medicaid expansion is not an option.

So, when the Joe Biden administration pushed through legislation to greatly enhance the already existing federal subsidies for exchange health insurance policies, the working poor in Mississippi – even extending to middle-class families – signed up en masse.

Mississippi had the second-highest increase in exchange enrollments – second only to Texas, which also had not expanded Medicaid. After the enhanced subsidies went into effect, Mississippi had a 242% increase to 338,159 people, according to KFF, a nationwide nonprofit that studies health care policy.

Of the 10 states with the recent highest declines in ACA enrollment after the enhanced subsidies ended, Mississippi and South Carolina were the only two that had not expanded Medicaid.

The enhanced subsidies ended in December 2025 after the Trump Administration and the Republican-led Congress refused to extend them. While multiple Republican lawmakers made efforts to pass legislation to extend the subsidies, U.S. Sens. Roger Wicker and Cindy Hyde-Smith and other Republican members of Mississippi's congressional delegation made no visible efforts to reinstate the enhanced federal aid.

As a result of the enhanced subsidies ending, KFF estimated that a 40-year-old Jacksonian earning $30,000 per year would see his or her monthly insurance cost increase from $42 to $155 for a policy purchased on the exchange.

Based on that calculation, it should not be a surprise that Mississippians are dropping the health insurance exchange policies. After all, they are dealing with higher costs for groceries, gasoline and other necessities at the same time they are being hit with higher health care insurance costs.

They are making the decision to drop the health insurance policies and hoping they do not get sick and understanding that if they do face a major medical bill with no insurance, they will be unable to pay it. The medical bills they cannot pay place a burden not only on them and their families, but also on the overall state health care system that must absorb those unpaid costs.

In short, Mississippi's working poor have been hit with rising health insurance exchange costs and no Medicaid expansion, meaning they have less access to health care than most Americans.

But the fact that poor Mississippians, facing higher costs, cannot afford health care should not be a surprise.

Is it even news?

Like the old adage goes, it is not news when dog bites man. It is news when man bites dog or when a poor Mississippian actually has access to decent health care.

Bobby Harrison, Mississippi Today's senior capitol reporter, covers politics, government and the Mississippi State Legislature. He can be reached at bharrison@mississippitoday.org

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