How Obamacare Went South In Mississippi, Part 4: "The Headquarters"

The elected insurance commissioner of Mississippi Mike Chaney holds the unenviable distinction of submitting the only state exchange application to be turned down by the federal government.

In the country's unhealthiest state, the failure of Obamacare is a group effort. Go here to read Part 3.

Sister Minnie Wilkinson was no crusader.

Her pastor, Michael Minor, had received some small acclaim when he banned fried chicken at Oak Hill church in an effort to help parishioners lose weight. The fried chicken ban was all right with Wilkinson who didn't mind the turkey sausage replacement and regularly attended Weight Watchers, but the ban on soda at church functions was tough to abide. She loved, absolutely loved, Dr. Pepper.

On the evening Pastor Minor learned the church had received one of just two grants to lead Obamacare sign-ups in Mississippi, he made an announcement during a service: "'This is the headquarters!' and we'd be working here five days a week," Wilkinson told me, sitting at a cluttered desk in the church office in Hernando. Wilkinson, 67, had no particular expertise in health care or passion for the uninsured; she was on Medicare and before that survived a few years without health coverage just fine. Her pastor needed her, though, and that was enough.

The enormity of the task soon became apparent when she saw the exam required by the federal government to become a navigator. "You can't make me believe that's a 20-hour test," said Wilkinson who doesn't have a college degree. She told her husband, "I'm getting too old for this."

Meanwhile, up in Washington, D.C., federal bureaucrats who had inherited the job of putting together an insurance marketplace in Mississippi were scrambling. There was a new worry. In the wake of Chaney's defeat, Mississippi's dominant insurer, Blue Cross Blue Shield, had pulled out, leaving only Magnolia Health Plan and Humana. And since the companies could choose where they wanted to operate, in 36 of Mississippi's 82 counties, not a single plan was for sale.

Federal regulators asked Chaney for help to get more counties covered, and though he was still furious about being spurned, he agreed to reach out to Blue Cross and United HealthCare. Both turned him down. Humana said it would consider his request to take just five more counties. A few weeks later, Heidi Margulis, Humana's senior vice president of public affairs, called Chaney with miraculous news. He remembers her saying, "'Well, Commissioner, we gonna make your day. You ready? We gonna cover all the counties.' I said, 'Heidi Margulis, I don't know you. I don't know what you look like. But if I could crawl through this phone, I'd kiss you.'"

Staggering Hurdles

When the federal website, HealthCare.gov, made its disastrous debut on Oct. 1, just four counties had two insurers competing for business; the rest had only a single choice. Federal regulators, Chaney told me, were lenient in approving the networks in order to give residents options. Customers chafed at the restrictions: "We didn't have a great product this year," said Conner Reeves at UMMC. In some counties, the local hospital wasn't in network and patients had to go elsewhere. "People were not very happy," Reeves told me.

Misconceptions plagued the effort early on, and those trying to sign up Mississippi's uninsured faced a staggering number of hurdles. Many people didn't understand how insurance worked, Jerrilyn Frazier, a UMMC navigator, told me. "They say, 'I'm only gonna have to pay $35?' and I tell them, 'No, that's after you meet your deductible,'" Frazier recalled. "And they're like, 'Well I only go [to the doctor] once. I'm not gonna meet a $500 deductible so what's the use of me having it?'"

Enrollment site counselors around the state told me many Mississippians thought "affordable" meant "free." At $403 a month, the Magnolia State had the third highest average premium in the country for ACA plans, although 94 percent of shoppers who enrolled eventually received a subsidy. Still, for many, bargain basement prices weren't cheap enough. After a lengthy and involved phone consultations, UMMC navigator Tineciaa Harris would tell shoppers their monthly premiums were $2, or even 57 cents.

"And they'd say, 'Well, I gotta think about it," Harris said. "A lot of people also feel like, well, it's 57 cents, it's $5, but I can still go to the emergency room." Harris tried to explain why that wasn't a good idea. "The first time it happened, I turned to Conner, 'Did they just turn down a plan? For 57 cents?'"

In an ominous display of territorial tensions, the fragile alliance of Obamacare groups couldn't even agree on a website to promote enrollment events. At the request of federal regulators, Roy Mitchell convened UMMC, Oak Hill, and the Cover Mississippi coalition which included Humana, American Cancer Society, Planned Parenthood and others for a series of planning meetings. (Magnolia Health Plan did not participate.) The two navigator recipients opted not to use the "Cover Mississippi" logo and website in their campaigns, and Pastor Minor unveiled his own rudimentary site, getcoveredms.org. The hospital association promoted a different site, covermississippi.org. "The groups in Mississippi found reasons not to work together," Tony Garr, regional manager for Enroll America, told me.

If there was one company that seemed to earn everyone's praise, it was Humana. The insurance company eagerly joined the Cover Mississippi coalition; it trained brokers and sales staff at its branded, retail outlets; and two buses—rigged with Wi-Fi and private cubicles—traversed the state, making hundreds of stops at Walmart parking lots, gas stations and Sunday church services. "Having a mobile outreach was a way to gain quick visibility and build our brand," said Humana's Stacey Carter. Although the state's final sign-up tally was meager, Humana's aggressive strategy would pay off: Of the 61,000 Mississippians who signed up for coverage, some 40,000 picked Humana.