Marketplace Coverage in Mississippi Fell 26 Percent in a Year. Some of Its Doctors Have Stopped Taking Insurance Altogether.

Analysis by DPC Insider — Policy Desk
#Mississippi#ACA marketplace#uninsured patients#Medicaid expansion#DPC legislation#practice economics
Sources: Disillusioned with the healthcare system, these physicians stopped taking insurance · Disillusioned with the healthcare system, these physicians stopped taking insurance (republication) · How Has ACA Marketplace Enrollment Changed Across States in 2026? · Mississippians brace for higher ACA premiums as enhanced subsidies near expiration · SB2687, Mississippi Direct Primary Care Act (2015 Regular Session) · SB2687 bill history, 2015 Regular Session (Approved by Governor 03/17, Chapter 369) · Status of State Medicaid Expansion Decisions · Characteristics of Poor Uninsured Adults Ages 19-64 in the ACA Coverage Gap · Direct Primary Care — American Academy of Family Physicians · Mississippi Doctors Ditch Insurance For A Direct Primary Care Model · Hall Health — Pricing Plans

Between February 2025 and February 2026, the number of Mississippians actually paying for a marketplace plan fell 26 percent. The state finished with the lowest effectuation rate of any state in the country.

In roughly the same window, Mississippi Today reported on September 3 on family physicians in the southern part of the state who have stopped billing insurance entirely and now run on monthly memberships. Two events, one state, and a connection that nobody has measured yet.

What the enrollment data actually shows

KFF’s July 28 analysis of federal data draws a distinction that matters here. Effectuated enrollment counts people who paid a premium. Plan selections during open enrollment count people who signed up. The gap between those two numbers is where 2026 got ugly.

Nationally, February effectuated enrollment dropped to 19.2 million people from 21.8 million a year earlier, a 12 percent decline. The national effectuation rate fell from 90 percent to 83 percent.

Mississippi’s landed at 61 percent. In KFF’s words, “nearly two in five consumers who signed up during open enrollment did not maintain coverage past January.” The state’s 26 percent drop in effectuated enrollment ties Louisiana’s and trails the 27 percent posted by Michigan, with seven states losing a steeper share.

The cause isn’t a mystery. Congress let the enhanced premium tax credits expire at the end of 2025. Mississippi Insurance Commissioner Mike Chaney warned in December of a “death spiral for the healthcare industry” if the newly uninsured shifted their care to emergency rooms. About 338,000 Mississippians had selected marketplace plans for 2025.

There’s no backstop underneath that. Mississippi is one of ten states that never adopted Medicaid expansion, and KFF counts 56,000 poor uninsured adults ages 19 to 64 in the state sitting in the coverage gap.

The practices

Dr. Rasheeda Hall opened Hall Health in Hattiesburg in 2024 after years of appointments she describes as too short to do the work. She now schedules 30 and 60 minute visits. About one in five of her patients carry no insurance at all.

Dr. Ashlee Hendry opened Mid-South Direct Primary Care in 2022, with offices in Petal and Hattiesburg. She had been seeing more than 30 patients a day inside a Memphis hospital system, a pace she compared to an assembly line. She caps her schedule at 12 now, with a waitlist behind it.

Dr. John Vanderloo, past president of the Mississippi Academy of Family Physicians, is the first DPC physician to have held that office. That’s a small detail with real weight. When a state’s family medicine society elects someone practicing outside the insurance system, the model has stopped being fringe in that state.

On price, Mississippi Today reports Mid-South charges $100 a month per adult, and Black Enterprise reports Hall Health’s individual membership at $125 a month. Hall Health’s own pricing page lists couples at $225 and families at $175, customized and not to exceed $350 a month, with a $100 enrollment fee on every tier. The American Academy of Family Physicians puts the general range at $50 to $100 a month. Rates vary by practice, location and what a given membership includes, so treat any single figure as one practice’s decision rather than a market price.

What the membership doesn’t buy

Mississippi legalized these arrangements more than a decade ago. The governor signed Senate Bill 2687, the Mississippi Direct Primary Care Act, in March 2015. The legislature’s bill history records it as Chapter 369 of that session, effective July 1. The text is direct about what a membership is: a direct primary care agreement “shall not be considered to be an insurance product,” and the provider isn’t engaged in the business of insurance for purposes of the state insurance code. Providers don’t need a certificate of authority to sell one.

That language is the reason the model is legal, and it’s also the boundary of what the model does. A membership buys primary care. It doesn’t buy a hospitalization, a cardiac catheterization, an oncology course or an air ambulance ride out of a rural county. Mississippi law is clear that patients shouldn’t confuse the two.

Robert Berenson of the Urban Institute made the harder version of this argument to Mississippi Today. Every physician who shrinks a panel pulls capacity out of a state that already has a shortage. Separately, the article reports that some health policy experts worry about who gets left behind when a practice converts. Berenson is right that the model doesn’t repair the payer system. It was never designed to.

The counterweight is that the physicians in this story weren’t going to keep practicing the old way. Hendry was on an assembly line. Hall was rushing. A physician who leaves medicine entirely removes the same capacity, and takes the DPC panel with them.

The Open Question

Nobody knows how many of the Mississippians who dropped marketplace coverage this year ended up in a direct primary care practice. Marketplace enrollment gets counted federally. Nothing in the Mississippi statute requires anyone to count memberships. DPC agreements sit outside the insurance code by design, and a provider who needs no certificate of authority files nothing that would produce a number.

So the most interesting number in this story doesn’t exist. If a meaningful share of the roughly one in four marketplace enrollees the state lost bought a $100 membership instead, that’s a coverage story nobody has an instrument to see. If almost none of them did, the two trends are running in parallel and touching nothing. Both readings fit the available evidence, and the reporting can’t settle it.