Health Care Affordability Fund; create to reduce premiums and cost sharing for health insurance purchased on the exchange.

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To: Insurance;
Appropriations A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Johnson

HOUSE BILL NO. 590

AN ACT TO CREATE THE HEALTH CARE AFFORDABILITY FUND AS A 1
SPECIAL FUND IN THE STATE TREASURY AND PROVIDE THAT THE FUND SHALL 2
BE ADMINISTERED BY THE COMMISSIONER OF INSURANCE; TO PROVIDE THAT 3
THE PURPOSE OF THE FUND IS TO REDUCE HEALTH CARE PREMIUMS AND COST 4
SHARING FOR MISSISSIPPI RESIDENTS WHO PURCHASE HEALTH CARE 5
COVERAGE ON THE FEDERAL HEALTH INSURANCE MARKETPLACE IN 6
MISSISSIPPI; TO PROVIDE THAT IF THE FEDERAL PATIENT PROTECTION AND 7
AFFORDABLE CARE ACT IS REPEALED IN FULL OR IN PART BY AN ACT OF 8
CONGRESS OR INVALIDATED BY THE UNITED STATES SUPREME COURT AND 9
ELIMINATES OR REDUCES COMPREHENSIVE HEALTH CARE COVERAGE FOR 10
MISSISSIPPI RESIDENTS THROUGH MEDICAID OR THE FEDERAL HEALTH 11
INSURANCE MARKETPLACE IN MISSISSIPPI, THE FUND MAY BE USED TO 12
MAINTAIN COVERAGE THROUGH THE FEDERAL HEALTH INSURANCE MARKETPLACE 13
IN MISSISSIPPI; TO DIRECT THE COMMISSIONER OF INSURANCE TO 14
PROMULGATE RULES TO PROVIDE ENHANCED PREMIUM AND COST-SHARING 15
ASSISTANCE TO INDIVIDUALS AND FAMILIES FOR THE PURCHASE OF 16
QUALIFIED HEALTH PLANS ON THE FEDERAL HEALTH INSURANCE MARKETPLACE 17
IN MISSISSIPPI; TO AMEND SECTIONS 27-15-103 AND 27-15-109, 18
MISSISSIPPI CODE OF 1972, TO PROVIDE AN ADDITIONAL ANNUAL LICENSE 19
OR PRIVILEGE TAX OF 3% OF THE GROSS AMOUNT OF PREMIUM RECEIPTS 20
RECEIVED FROM, AND ON INSURANCE POLICIES AND CONTRACTS WRITTEN IN, 21
OR COVERING RISKS LOCATED IN THIS STATE BY FOREIGN AND DOMESTIC 22
HEALTH INSURANCE COMPANIES AND ASSOCIATIONS DOING BUSINESS IN THIS 23
STATE; AND FOR RELATED PURPOSES. 24
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 25
SECTION 1. (1) The Health Care Affordability Fund is 26
created as a special fund in the State Treasury. The fund shall 27
consist of the insurance premium taxes collected under Sections 28
27-15-103(4) and 27-15-109(4), distributions, appropriations, 29
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gifts, grants, donations and funds from any other source made 30
available for the fund. The fund shall be administered by the 31
Commissioner of Insurance, and monies in the fund may be expended 32
by the commissioner, upon appropriation by the Legislature, for 33
purposes provided by this section. Unexpended amounts remaining 34
in the fund at the end of a fiscal year shall not lapse into the 35
State General Fund, and any interest earned on amounts in the fund 36
shall be deposited to the credit of the special fund. 37
(2) The purpose of the fund is to: 38
(a) Reduce health care premiums and cost sharing for 39
Mississippi residents who purchase health care coverage on the 40
federal health insurance marketplace in Mississippi; 41
(b) Reduce premiums for small businesses and their 42
employees purchasing health care coverage in the fully insured 43
small group market; 44
(c) Provide resources for planning, design and 45
implementation of health care coverage initiatives for uninsured 46
Mississippi residents; and 47
(d) Provide resources for administration of state 48
health care coverage initiatives for uninsured Mississippi 49
residents. 50
(3) If the federal Patient Protection and Affordable Care 51
Act is repealed in full or in part by an act of Congress or 52
invalidated by the United States Supreme Court and eliminates or 53
reduces comprehensive health care coverage for Mississippi 54
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residents through Medicaid or the federal health insurance 55
marketplace in Mississippi, the fund may be used to maintain 56
coverage through the federal health insurance marketplace in 57
Mississippi, provided that coverage is prioritized for Mississippi 58
residents with incomes below two hundred percent (200%) of the 59
federal poverty level. 60
(4) Before July 1 of each year, the commissioner shall 61
provide actuarial data from the Health Care Affordability Fund to 62
the Legislative Budget Committee. 63
(5) Before July 1 of each year, the commissioner, in 64
consultation with the Executive Director of Human Services and the 65
Commissioner of Revenue, shall work with the Legislative Budget 66
Committee and the Department of Finance and Administration to 67
develop and report on performance measures relating to the Health 68
Care Affordability Fund and any programs or initiatives funded by 69
the fund. 70
SECTION 2. (1) The Commissioner of Insurance shall 71
promulgate rules to: 72
(a) Provide enhanced premium and cost-sharing 73
assistance to individuals and families for the purchase of 74
qualified health plans on the federal health insurance marketplace 75
in Mississippi. In providing this assistance, the commissioner 76
shall develop health care affordability criteria designed to 77
reduce the amount that individuals pay in premiums and 78
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out-of-pocket medical expenses for qualified health plans offered 79
on the federal health insurance marketplace in Mississippi; and 80
(b) Establish income eligibility parameters for the 81
health care affordability criteria for plan year 2027 and each 82
subsequent calendar year based on available funds. Mississippi 83
residents who qualify must have an income that is eligible for 84
advanced premium tax credits under the federal Patient Protection 85
and Affordable Care Act. 86
(2) The commissioner, in consultation with the Department of 87
Human Services, the State Department of Health and stakeholder 88
groups, including health care providers that serve uninsured 89
residents, health insurance carriers and consumer advocacy groups, 90
shall develop a plan for extending health care coverage access to 91
uninsured Mississippi residents who do not qualify for federal 92
premium assistance or, except by reason of incarceration, 93
qualified health plans, through the federal health insurance 94
marketplace in Mississippi. No later than October 1, 2026, the 95
commissioner shall submit the plan to the Legislative Budget 96
Committee, the House Public Health and Human Services Committee 97
and the Senate Public Health and Welfare Committee that could 98
offer health care coverage for eligible Mississippi residents 99
beginning January 1, 2027. The plan shall include: 100
(a) Details about health care benefits; 101
(b) Health care affordability criteria designed to 102
reduce the amount that individuals pay in premiums and 103
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out-of-pocket medical expenses under the plan and that result in, 104
to the greatest extent possible, health care costs comparable to 105
costs for Mississippi residents for whom assistance is provided 106
under subsection (1) of this section; and 107
(c) Income eligibility parameters that prioritize 108
eligibility for Mississippi residents with incomes under two 109
hundred percent (200%) of the federal poverty level. 110
(3) On or before October 31, 2027 and each October 31 111
thereafter, the commissioner shall submit a report to the 112
Legislative Budget Committee, the House Public Health and Human 113
Services Committee and the Senate Public Health and Welfare 114
Committee, which shall include: 115
(a) A summary of the affordability criteria implemented 116
pursuant to subsections (1) and (2) of this section; 117
(b) The estimated number of uninsured Mississippi 118
residents who enrolled in coverage following implementation of the 119
affordability criteria pursuant to subsections (1) and (2) of this 120
section; and 121
(c) The amount in reduced costs and coverage assistance 122
the initiatives provided in the current and previous calendar 123
years by income level, county and coverage source. 124
SECTION 3. Section 27-15-103, Mississippi Code of 1972, is 125
amended as follows: 126
27-15-103. (1) Except as otherwise provided in Section 127
83-61-11, in addition to the license tax now or hereafter provided 128
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by law, which tax shall be paid when the company enters or is 129
admitted to do business in this state, there is * * * levied and 130
imposed upon all foreign insurance companies and associations, 131
including life insurance companies and associations, health, 132
accident and industrial insurance companies and associations, fire 133
and casualty insurance companies and associations, and all other 134
foreign insurance companies and associations of every kind and 135
description, an additional annual license or privilege tax of 136
three percent (3%) of the gross amount of premium receipts 137
received from, and on insurance policies and contracts written in, 138
or covering risks located in this state, except for premiums 139
received on policies issued to fund a deferred compensation plan 140
qualified under Section 457 of the Federal Tax Code for federal 141
tax exemption. In determining * * * the amount of premiums, there 142
shall be deducted therefrom premiums received for reinsurance from 143
companies authorized to do business in this state, cash dividends 144
paid under policy contracts in this state, and premiums returned 145
to policyholders and cancellations on accounts of policies not 146
taken, and, in the case of mutual insurance companies (including 147
interinsurance and reciprocal exchanges, but not including mutual 148
life, accident, health or industrial insurance companies) any 149
refund made or credited to the policyholder other than for losses. 150
The term "premium" as used herein shall also include policy fees, 151
membership fees, and all other fees collected by the companies. 152
No credit or deduction from gross premium receipts shall be 153
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allowed for any commission, fee or compensation paid to any agent, 154
solicitor or representative. * * * However, * * * any foreign 155
insurance carrier selected to furnish service to the State of 156
Mississippi under the State Employees Life and Health Insurance 157
Plan shall not be required to pay the annual license or privilege 158
tax on the premiums collected for coverage under the * * * plan. 159
(2) In the event that the Mississippi Supreme Court or 160
another court finally adjudicates that any tax levied prior to 161
July 1, 1985, under the provisions of this section was collected 162
unconstitutionally and that a liability for a credit or refund for 163
such collection has accrued, then the rate of tax set forth above 164
shall be increased to four percent (4%) for a period of six (6) 165
years beginning July 1 following such adjudication. 166
(3) The taxes herein levied and imposed for the calendar 167
year 1982 and all calendar years thereafter shall be reduced by 168
the net amount of income tax paid to this state for the preceding 169
calendar year, provided, in no event may the credit be taken more 170
than once. The credit herein authorized shall, in no event, be 171
greater than the premium tax due under this section; it being the 172
purpose and intent of this paragraph that whichever of the annual 173
insurance premium tax or the income tax is greater in amount shall 174
be paid. 175
(4) (a) In addition to the license tax now or hereafter 176
provided by law and the tax provided in subsection (1) of this 177
section, which tax shall be paid when the company enters or is 178
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admitted to do business in this state, there is levied and imposed 179
upon all foreign health insurance companies and associations an 180
annual license or privilege tax of three percent (3%) of the gross 181
amount of premium receipts received from, and on insurance 182
policies and contracts written in, or covering risks located in 183
this state, except for premiums received on policies issued to 184
fund a deferred compensation plan qualified under Section 457 of 185
the Federal Tax Code for federal tax exemption. The additional 186
annual tax collected under this paragraph shall be deposited by 187
the Department of Revenue into the Health Care Affordability Fund 188
created in Section 1 of this act. 189
(b) If an act of the United States Congress is signed 190
into law that imposes the annual fee on health insurance providers 191
pursuant to Section 9010 of the federal Patient Protection and 192
Affordable Care Act, or that imposes a substantially similar fee 193
on the same class of taxpayers, the rate of the additional annual 194
tax shall be decreased at a rate equal to the rate of the annual 195
fee imposed; however, the rate of the additional annual tax shall 196
not be less than one percent (1%). A reduction in the additional 197
annual tax pursuant to this paragraph shall go into effect on the 198
later of the effective date of the imposition of the federal 199
annual fee or ninety (90) days after the congressional act 200
imposing the federal annual fee is signed into law. 201
SECTION 4. Section 27-15-109, Mississippi Code of 1972, is 202
amended as follows: 203
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27-15-109. (1) Except as otherwise provided in Section 204
83-61-11, there is * * * levied and imposed upon each domestic 205
company doing business in this state an annual tax of three 206
percent (3%) of the gross amount of premiums collected by such 207
domestic company on insurance policies and contracts written in, 208
or covering risks located in this state, except for premiums 209
received on policies issued to fund a retirement, thrift or 210
deferred compensation plan qualified under Section 401, Section 211
403 or Section 457 of the Federal Tax Code for federal tax 212
exemption. * * * However, * * * a domestic insurance company 213
against which is levied additional premium tax under retaliatory 214
laws of other states in which it does business, as a result of the 215
tax increase provided by Sections 27-15-103 through 27-15-117, may 216
deduct the total of such additional retaliatory tax from the state 217
income tax due by it to the State of Mississippi. The insurance 218
carriers selected to furnish service to the State of Mississippi, 219
under the State Employees Life and Health Insurance Plan, shall 220
not be required to pay the premium tax levied against insurance 221
companies under this section on the premiums collected for 222
coverage under the state employees plan. 223
(2) Except as expressly provided by subsection (1) of this 224
section, all of the provisions of Sections 27-15-103 through 225
27-15-117 shall be applicable to such domestic insurance 226
companies. However, the statement filed with the State Tax 227
Commission by domestic insurance companies as provided in Section 228
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27-15-107 shall include therein a sworn statement of all 229
additional retaliatory premium taxes paid by them to other states 230
as a result of the increase in premium taxes imposed by Sections 231
27-15-103 through 27-15-117, itemized by states to which paid. 232
(3) In the event that the Mississippi Supreme Court or 233
another court finally adjudicates that any tax levied prior to 234
July 1, 1985, under the provisions of this section was collected 235
unconstitutionally and that a liability for a credit or refund for 236
such collection has accrued, then the rate of tax set forth above 237
shall be increased to four percent (4%) for a period of six (6) 238
years beginning July 1 following such adjudication. 239
(4) (a) In addition to the license tax now or hereafter 240
provided by law and the tax provided in subsection (1) of this 241
section, there is levied and imposed upon each domestic health 242
insurance company doing business in this state an annual tax of 243
three percent (3%) of the gross amount of premiums collected by 244
such domestic company on insurance policies and contracts written 245
in, or covering risks located in this state, except for premiums 246
received on policies issued to fund a retirement, thrift or 247
deferred compensation plan qualified under Section 401, Section 248
403 or Section 457 of the Federal Tax Code for federal tax 249
exemption. The additional annual tax collected under this 250
paragraph shall be deposited by the Department of Revenue into the 251
Health Care Affordability Fund created in Section 1 of this act. 252
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ST: Health Care Affordability Fund; create to
reduce premiums and cost sharing for health
insurance purchased on the exchange.
(b) If an act of the United States Congress is signed 253
into law that imposes the annual fee on health insurance providers 254
pursuant to Section 9010 of the federal Patient Protection and 255
Affordable Care Act, or that imposes a substantially similar fee 256
on the same class of taxpayers, the rate of the additional annual 257
tax shall be decreased at a rate equal to the rate of the annual 258
fee imposed; however, the rate of the additional annual tax shall 259
not be less than one percent (1%). A reduction in the additional 260
annual tax pursuant to this paragraph shall go into effect on the 261
later of the effective date of the imposition of the federal 262
annual fee or ninety (90) days after the congressional act 263
imposing the federal annual fee is signed into law. 264
SECTION 5. This act shall take effect and be in force from 265
and after its passage. 266