House Bill 590

AN ACT TO CREATE THE HEALTH CARE AFFORDABILITY FUND AS A SPECIAL FUND IN THE STATE TREASURY AND PROVIDE THAT THE FUND SHALL BE ADMINISTERED BY THE COMMISSIONER OF INSURANCE; TO PROVIDE THAT THE PURPOSE OF THE FUND IS TO REDUCE HEALTH CARE PREMIUMS AND COST SHARING FOR MISSISSIPPI RESIDENTS WHO PURCHASE HEALTH CARE COVERAGE ON THE FEDERAL HEALTH INSURANCE MARKETPLACE IN MISSISSIPPI; TO PROVIDE THAT IF THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT IS REPEALED IN FULL OR IN PART BY AN ACT OF CONGRESS OR INVALIDATED BY THE UNITED STATES SUPREME COURT AND ELIMINATES OR REDUCES COMPREHENSIVE HEALTH CARE COVERAGE FOR MISSISSIPPI RESIDENTS THROUGH MEDICAID OR THE FEDERAL HEALTH INSURANCE MARKETPLACE IN MISSISSIPPI, THE FUND MAY BE USED TO MAINTAIN COVERAGE THROUGH THE FEDERAL HEALTH INSURANCE MARKETPLACE IN MISSISSIPPI; TO DIRECT THE COMMISSIONER OF INSURANCE TO PROMULGATE RULES TO PROVIDE ENHANCED PREMIUM AND COST-SHARING ASSISTANCE TO INDIVIDUALS AND FAMILIES FOR THE PURCHASE OF QUALIFIED HEALTH PLANS ON THE FEDERAL HEALTH INSURANCE MARKETPLACE IN MISSISSIPPI; TO AMEND SECTIONS 27-15-103 AND 27-15-109, MISSISSIPPI CODE OF 1972, TO PROVIDE AN ADDITIONAL ANNUAL LICENSE OR PRIVILEGE TAX OF 3% OF THE GROSS AMOUNT OF PREMIUM RECEIPTS RECEIVED FROM, AND ON INSURANCE POLICIES AND CONTRACTS WRITTEN IN, OR COVERING RISKS LOCATED IN THIS STATE BY FOREIGN AND DOMESTIC HEALTH INSURANCE COMPANIES AND ASSOCIATIONS DOING BUSINESS IN THIS STATE; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) The Health Care Affordability Fund is created as a special fund in the State Treasury. The fund shall consist of the insurance premium taxes collected under Sections 27-15-103(4) and 27-15-109(4), distributions, appropriations, gifts, grants, donations and funds from any other source made available for the fund. The fund shall be administered by the Commissioner of Insurance, and monies in the fund may be expended by the commissioner, upon appropriation by the Legislature, for purposes provided by this section. Unexpended amounts remaining in the fund at the end of a fiscal year shall not lapse into the State General Fund, and any interest earned on amounts in the fund shall be deposited to the credit of the special fund.

(2) The purpose of the fund is to:

(a) Reduce health care premiums and cost sharing for Mississippi residents who purchase health care coverage on the federal health insurance marketplace in Mississippi;

(b) Reduce premiums for small businesses and their employees purchasing health care coverage in the fully insured small group market;

(c) Provide resources for planning, design and implementation of health care coverage initiatives for uninsured Mississippi residents; and

(d) Provide resources for administration of state health care coverage initiatives for uninsured Mississippi residents.

(3) If the federal Patient Protection and Affordable Care Act is repealed in full or in part by an act of Congress or invalidated by the United States Supreme Court and eliminates or reduces comprehensive health care coverage for Mississippi residents through Medicaid or the federal health insurance marketplace in Mississippi, the fund may be used to maintain coverage through the federal health insurance marketplace in Mississippi, provided that coverage is prioritized for Mississippi residents with incomes below two hundred percent (200%) of the federal poverty level.

(4) Before July 1 of each year, the commissioner shall provide actuarial data from the Health Care Affordability Fund to the Legislative Budget Committee.

(5) Before July 1 of each year, the commissioner, in consultation with the Executive Director of Human Services and the Commissioner of Revenue, shall work with the Legislative Budget Committee and the Department of Finance and Administration to develop and report on performance measures relating to the Health Care Affordability Fund and any programs or initiatives funded by the fund.

SECTION 2. (1) The Commissioner of Insurance shall promulgate rules to:

(a) Provide enhanced premium and cost-sharing assistance to individuals and families for the purchase of qualified health plans on the federal health insurance marketplace in Mississippi. In providing this assistance, the commissioner shall develop health care affordability criteria designed to reduce the amount that individuals pay in premiums and out-of-pocket medical expenses for qualified health plans offered on the federal health insurance marketplace in Mississippi; and

(b) Establish income eligibility parameters for the health care affordability criteria for plan year 2027 and each subsequent calendar year based on available funds. Mississippi residents who qualify must have an income that is eligible for advanced premium tax credits under the federal Patient Protection and Affordable Care Act.

(2) The commissioner, in consultation with the Department of Human Services, the State Department of Health and stakeholder groups, including health care providers that serve uninsured residents, health insurance carriers and consumer advocacy groups, shall develop a plan for extending health care coverage access to uninsured Mississippi residents who do not qualify for federal premium assistance or, except by reason of incarceration, qualified health plans, through the federal health insurance marketplace in Mississippi. No later than October 1, 2026, the commissioner shall submit the plan to the Legislative Budget Committee, the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee that could offer health care coverage for eligible Mississippi residents beginning January 1, 2027. The plan shall include:

(a) Details about health care benefits;

(b) Health care affordability criteria designed to reduce the amount that individuals pay in premiums and out-of-pocket medical expenses under the plan and that result in, to the greatest extent possible, health care costs comparable to costs for Mississippi residents for whom assistance is provided under subsection (1) of this section; and

(c) Income eligibility parameters that prioritize eligibility for Mississippi residents with incomes under two hundred percent (200%) of the federal poverty level.

(3) On or before October 31, 2027 and each October 31 thereafter, the commissioner shall submit a report to the Legislative Budget Committee, the House Public Health and Human Services Committee and the Senate Public Health and Welfare Committee, which shall include:

(a) A summary of the affordability criteria implemented pursuant to subsections (1) and (2) of this section;

(b) The estimated number of uninsured Mississippi residents who enrolled in coverage following implementation of the affordability criteria pursuant to subsections (1) and (2) of this section; and

(c) The amount in reduced costs and coverage assistance the initiatives provided in the current and previous calendar years by income level, county and coverage source.

SECTION 3. Section 27-15-103, Mississippi Code of 1972, is amended as follows:

27-15-103. (1) Except as otherwise provided in Section 83-61-11, in addition to the license tax now or hereafter provided by law, which tax shall be paid when the company enters or is admitted to do business in this state, there is * * *~~hereby~~ levied and imposed upon all foreign insurance companies and associations, including life insurance companies and associations, health, accident and industrial insurance companies and associations, fire and casualty insurance companies and associations, and all other foreign insurance companies and associations of every kind and description, an additional annual license or privilege tax of three percent (3%) of the gross amount of premium receipts received from, and on insurance policies and contracts written in, or covering risks located in this state, except for premiums received on policies issued to fund a deferred compensation plan qualified under Section 457 of the Federal Tax Code for federal tax exemption. In determining * * *~~said~~ the amount of premiums, there shall be deducted therefrom premiums received for reinsurance from companies authorized to do business in this state, cash dividends paid under policy contracts in this state, and premiums returned to policyholders and cancellations on accounts of policies not taken, and, in the case of mutual insurance companies (including interinsurance and reciprocal exchanges, but not including mutual life, accident, health or industrial insurance companies) any refund made or credited to the policyholder other than for losses. The term "premium" as used herein shall also include policy fees, membership fees, and all other fees collected by the companies. No credit or deduction from gross premium receipts shall be allowed for any commission, fee or compensation paid to any agent, solicitor or representative. * * *~~Provided,~~ However, * * *~~that~~ any foreign insurance carrier selected to furnish service to the State of Mississippi under the State Employees Life and Health Insurance Plan shall not be required to pay the annual license or privilege tax on the premiums collected for coverage under the * * *~~said~~ plan.

(2) In the event that the Mississippi Supreme Court or another court finally adjudicates that any tax levied prior to July 1, 1985, under the provisions of this section was collected unconstitutionally and that a liability for a credit or refund for such collection has accrued, then the rate of tax set forth above shall be increased to four percent (4%) for a period of six (6) years beginning July 1 following such adjudication.

(3) The taxes herein levied and imposed for the calendar year 1982 and all calendar years thereafter shall be reduced by the net amount of income tax paid to this state for the preceding calendar year, provided, in no event may the credit be taken more than once. The credit herein authorized shall, in no event, be greater than the premium tax due under this section; it being the purpose and intent of this paragraph that whichever of the annual insurance premium tax or the income tax is greater in amount shall be paid.

(4) (a) In addition to the license tax now or hereafter provided by law and the tax provided in subsection (1) of this section, which tax shall be paid when the company enters or is admitted to do business in this state, there is levied and imposed upon all foreign health insurance companies and associations an annual license or privilege tax of three percent (3%) of the gross amount of premium receipts received from, and on insurance policies and contracts written in, or covering risks located in this state, except for premiums received on policies issued to fund a deferred compensation plan qualified under Section 457 of the Federal Tax Code for federal tax exemption. The additional annual tax collected under this paragraph shall be deposited by the Department of Revenue into the Health Care Affordability Fund created in Section 1 of this act.

(b) If an act of the United States Congress is signed into law that imposes the annual fee on health insurance providers pursuant to Section 9010 of the federal Patient Protection and Affordable Care Act, or that imposes a substantially similar fee on the same class of taxpayers, the rate of the additional annual tax shall be decreased at a rate equal to the rate of the annual fee imposed; however, the rate of the additional annual tax shall not be less than one percent (1%). A reduction in the additional annual tax pursuant to this paragraph shall go into effect on the later of the effective date of the imposition of the federal annual fee or ninety (90) days after the congressional act imposing the federal annual fee is signed into law.

SECTION 4. Section 27-15-109, Mississippi Code of 1972, is amended as follows:

27-15-109. (1) Except as otherwise provided in Section 83-61-11, there is * * *~~hereby~~ levied and imposed upon each domestic company doing business in this state an annual tax of three percent (3%) of the gross amount of premiums collected by such domestic company on insurance policies and contracts written in, or covering risks located in this state, except for premiums received on policies issued to fund a retirement, thrift or deferred compensation plan qualified under Section 401, Section 403 or Section 457 of the Federal Tax Code for federal tax exemption. * * *~~Provided,~~ However, * * *~~that~~ a domestic insurance company against which is levied additional premium tax under retaliatory laws of other states in which it does business, as a result of the tax increase provided by Sections 27-15-103 through 27-15-117, may deduct the total of such additional retaliatory tax from the state income tax due by it to the State of Mississippi. The insurance carriers selected to furnish service to the State of Mississippi, under the State Employees Life and Health Insurance Plan, shall not be required to pay the premium tax levied against insurance companies under this section on the premiums collected for coverage under the state employees plan.

(2) Except as expressly provided by subsection (1) of this section, all of the provisions of Sections 27-15-103 through 27-15-117 shall be applicable to such domestic insurance companies. However, the statement filed with the State Tax Commission by domestic insurance companies as provided in Section 27-15-107 shall include therein a sworn statement of all additional retaliatory premium taxes paid by them to other states as a result of the increase in premium taxes imposed by Sections 27-15-103 through 27-15-117, itemized by states to which paid.

(3) In the event that the Mississippi Supreme Court or another court finally adjudicates that any tax levied prior to July 1, 1985, under the provisions of this section was collected unconstitutionally and that a liability for a credit or refund for such collection has accrued, then the rate of tax set forth above shall be increased to four percent (4%) for a period of six (6) years beginning July 1 following such adjudication.

(4) (a) In addition to the license tax now or hereafter provided by law and the tax provided in subsection (1) of this section, there is levied and imposed upon each domestic health insurance company doing business in this state an annual tax of three percent (3%) of the gross amount of premiums collected by such domestic company on insurance policies and contracts written in, or covering risks located in this state, except for premiums received on policies issued to fund a retirement, thrift or deferred compensation plan qualified under Section 401, Section 403 or Section 457 of the Federal Tax Code for federal tax exemption. The additional annual tax collected under this paragraph shall be deposited by the Department of Revenue into the Health Care Affordability Fund created in Section 1 of this act.

SECTION 5. This act shall take effect and be in force from and after its passage.