Today, Oct. 1, 2013, marks day one of the health-insurance exchanges as outlined in the 2010 Affordable Care Act, aka "Obamacare," President Barack Obama's landmark health-insurance reform act. Open enrollment runs through March 31, 2014, with coverage beginning as soon as Jan. 1, 2014.

The exchanges go into effect regardless of whether Congress passes a continuing resolution on the federal budget, because the marketplaces are categorized as mandatory, not discretionary spending. In Mississippi, the federal government will run the exchange, although the state's insurance commission has control over the rates and plans. That's not how it was supposed to work, but because of a fundamental difference of opinion between Gov. Phil Bryant and Insurance Commissioner Mike Chaney, the feds stepped in and took over.

Under the law, millions of uninsured and under-insured Americans can now purchase comprehensive health insurance via an Internet marketplace, mostly free from exorbitant insurance pricing for individuals not participating in group plans and free from the insurance industry's "pre-existing conditions" exclusions. All of the plans must provide essential health benefits, and include at least the following items and services, the website healthcare.gov reports:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)

• Emergency services

• Hospitalization (such as surgery)

• Maternity and newborn care (care before and after your baby is born)

• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

• Prescription drugs

• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

• Laboratory services

• Preventive and wellness services and chronic disease management

• Pediatric services

More expensive plans provide additional types of coverage and lower deductibles.

Any Mississippian who does not receive health insurance through his or her job and who does not qualify for Medicaid can buy insurance on the exchange. A large number of people who buy insurance on the exchange will also qualify for federally funded subsidies. Those subsidies will be available to individuals and families with incomes of up to 400 percent of the federal poverty level: For individuals, the top-end subsidized income is $45,960; for a family of four, the income level is $94,200.

The Mississippi Institutions of Higher Learning estimate that about 275,000 Mississippians will buy insurance through the exchange, of which, 229,000 will qualify for subsidies, which can bring out-of-pocket costs down to (or close to) zero. About 20 percent of Mississippians do not have health coverage of any kind, or roughly 600,000 people.

"There are two ways you can (get the subsidies)," said Mississippi Health Advocacy Program Director Jarvis Dortch, "One is that the tax credit, or subsidy, will go directly to the carrier you choose, so you only pay the left-over amount for your premium. The other way is that you can pay for your premium all at once, and the next year you can file for a bigger tax refund."

Those who choose not to purchase insurance will be levied a fine, starting at $95 or 1 percent of their income in 2014 and rising every year thereafter.

The Mississippi exchange will offer the third-highest rates in the nation before subsidies. First, Mississippians have serious health issues. We regularly rank at or near the worst in health markers such as obesity, diabetes, heart disease and infant mortality. Second, only two insurers have agreed to offer insurance on the exchanges: Humana and Magnolia Health. Fewer insurers mean less competition, thus, less pressure to provide competitive rates. As more companies join the Mississippi exchange and more people sign up for health insurance—especially healthy people—the hope is that premiums will fall.

"The ideas is that with health insurance, it's the start of lowering those poor health outcomes, or raise those outcomes, however you want to look at it," Dortch said.

Adding a few more barriers to actually getting health care to the state's needy citizens is the constant barrage of misinformation from those who oppose the law. That campaign, in concert with little hard information from the law's designers about how it will work for individuals and businesses has left many citizens confused. With the feds now in charge of Mississippi's exchange, the state lost millions that would have gone toward outreach and education programs. Arkansas, for example, is using federal funds for a "Census approach," Dortch said, going door to door to sign people up.

Earlier this year, the Mississippi Health Advocacy Program commissioned a survey to find out just how much Mississippians understand about the law and where health-care advocates needed to focus to ensure those who needed coverage would get it. The survey questioned 975 families who would be eligible for health insurance on the exchange. Nearly half (47.7 percent) were unaware that Mississippi would even have an exchange, and more than three quarters (76 percent) did not know that enrollment begins today.

People believe because Mississippi is not choosing to expand its Medicaid program under the law, that the exchanges aren't happening here either, Dortch said.

"Then there's confusion about the premiums," on top of the other confusion, he said. "People put a $400 amount up there, and you think that's what you're going to have to pay. You have to get past all that and let people know what's actually going to come out of their pockets," which may be far less.

Mississippi also has a health-care provider shortage, especially in rural areas. The U.S. Department of Agriculture designated 49 of Mississippi's 82 counties as "health care professional shortage areas" in 2012, meaning that even if people can buy insurance, the doctors and dentists in the area may not have the capacity to serve additional patients. That may leave many Mississippians, even those with insurance, with no access to even a primary-care physician or dentist.

The Mississippi Health Advocacy has joined with numerous organizations to provide information to Mississippians with questions about the exchange. Under the name Cover Mississippi, the organization is "pulling together ... to provide one place people can go to—consumers can go to—to find information," Dortch said. The organization has also made a few advertising buys to "push people toward enrollment."

"We've been holding meetings across the state, and the closer (they were) to October, the larger the attendance," he added. "We think that as these things come on line, more people are going to show an interest and want to know how it works."

For more information, visit HealthCare.gov, coverms.org or call 601-353-0845. Also, read the Jackson Free Press' continuing coverage of the Affordable Care Act in Mississippi.