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TUPELO • Health insurance doesn’t come cheap for anyone.

On average, 2018 premiums for employer-based insurance cost $5,993 annually for single coverage and $17,384 for family coverage, based on an analysis of federal data published this week by the Commonwealth Fund. Mississippi businesses are still picking up the lion’s share, with employees kicking in an average of $1,365 in annual premiums for single coverage and $5,680 for family coverage in 2018.

When the average employee contribution and deductible – $7,863 – are measured against the median income, Mississippi households could face costs of 16.5 percent of median income.

A decade ago, premiums for employer-based coverage averaged nearly $1,900 less for single coverage and about $6,000 less for Mississippi families. The employee share averaged $749 for single coverage and $1,365.

In 2008, the average employee contribution and deductible came in at 10.8 percent of household income.

Employers are asking employees to pay a bigger share of costs, but they don’t have much leverage against higher health care costs, said Dr. David Blumenthal, president of the Commonwealth Fund, a non-partisan foundation focused on improving performing health care systems.

“Employers are in a real bind,” Blumenthal said.

Higher prices

The rise in health care premiums does track increases in health care prices. Between 2007 and 2017, the national averages for inpatient day expenses went from $1,696 to $2,424, according to an analysis of American Hospital Association data by the Kaiser Family Foundation.

In Mississippi, they haven’t gone up as fast as expenses in the rest of the country. In 2007, average inpatient day expenses at Mississippi hospitals were $1,179 in 2010 to an average of $1,349 in 2017.

“Mississippi hospitals really have among the lowest expenses of any other hospitals in the state,” said Richard Roberson, Mississippi Hospital Association vice president. “The problem is there is only so much you can trim without jeopardizing patient care.”

Per capita payments for Medicare and Medicaid have remained largely stable over the decade, Blumenthal said. There are a number of factors at play, but even the biggest companies don’t have a large share of the healthcare marketplace in most towns and cities and don’t have a lot of bargaining power. It’s why Amazon, Berkshire Hathaway and Apple have created a joint venture to try to bend the curve.

“Employers have not found a way to negotiate lower prices,” Blumenthal said. “They have a real dilemma right now.”

For hospitals, there is no negotiating for rates with Medicare and Medicaid, Roberson said. There is no where else for increased expenses to land except with commercial insurers.

“The problem is you can only control so much,” Roberson said. “The costs and the cost of living has outpaced household income.”

Most Mississippi hospitals are operating on 1 to 2 percent margins of revenue over expenses, Roberson said. A few are doing better, but a number are operating in the red.

Across the state, hospitals are seeing patients struggling with high deductible plans, Roberson said.

“It’s really patients that get impacted,” Roberson said. “They don’t seek out the services and preventive care they need.”

The National Financial Capability Study found that Mississippians are more likely to have overdue medical bills. In 2018, 41 percent of Mississippians had overdue medical bills, compared to 23 percent nationally.

Staying in the game

Despite the increasing costs, the percentage of Mississippi employers offering health insurance has remained fairly consistent, according to an analysis of American Community Survey data gathered by the U.S. Census Bureau.

“It’s gone up and down, but it has been consistently at or above 80 percent going back to 2006,” Zach Smith, deputy director of the Center for Mississippi Health Policy.

In Mississippi, 58 percent of adults 19-64 are covered by employer-based insurance. The larger the employer, the more likely they are to offer health insurance than smaller employers. Ninety-seven percent of Mississippi employers with 50 or more employees offer insurance; 20 percent of employers with fewer than 10 employees offer insurance.

Between 2012 and 2017, Mississippi saw an increase in the number of people with private insurance and the rate of uninsured adults between 19 and 64 decreased from a high of 20 percent in 2013 to 13 percent in 2017.

“The majority of people who are uninsured are working,” Smith said.

Of the 864,000 people working in Mississippi, 569,000 are eligible for employer-based insurance and 411,000 enroll. The percentage of employees participating in family employer-based coverage has declined since 2006, but this was not statistically significant.

The report from the Center for Mississippi Health Policy does not speculate on why people are uninsured or opt out of employer-based insurance. The center’s goal is to present this data as objectively as possible.

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