As Mississippi battles the outbreak of coronavirus, a study that ranks states on their openness and access to healthcare places the state mid-pack nationally.

The Healthcare Openness and Access Project, authored by three scholars from the Mercatus Center at George Mason University, ranked Mississippi 24th. The study measures the extent of control a state exercises over healthcare and the authors used 41 different indicators grouped in five categories.

The authors — Jared Rhoads, Dr. Darcy Bryan M.D., and Robert Graboyes — scored each state in each indicator on a 1 to 5 scale, with 5 being the best score. Then the scores for each indicator were averaged in their categories. Each state’s total score is an average of the five categories. Mississippi scored a 3.29, slightly above the national average of 3.27.

Rhoads said the new edition has some differences over the first index released in 2018, including moving some indicators from one category to another and reducing the number of categories from 10 to five.

“The result is more easily digestible now and what we’re hearing from readers and reviewers, it is a more intuitive way of organizing the data,” Rhoads said. “We wanted to give a general feel on how restrictive a state is versus how much it can liberate people to do what they think is best.”

In the professional regulation category, Mississippi scored well (3.40, above the U.S. average of 3.14) for being part of the Interstate Medical Licensure Compact (29 states participate), fewer optician licensing requirements and broad scope of practice for behavioral health providers and midwives. It scored poorly on scope of practice for dental hygienists and overly restrictive licensing of certified registered nurse anesthetists.

In the institutional regulation category, Mississippi scored a 2.83, below the national average of 2.96. This category measures how much control state regulators impose over the business operations of healthcare institutions such as hospitals and pharmacies.

The state’s certificate of need program has more restrictions than most, receiving a score of 2. The state’s hospital taxes (up to $2 per patient bed per day) and raft of restrictions on compounding pharmacies also drew low marks from the study authors.

Mississippi law requires CON approval for all projects that increase the bed complement or a capital expenditure of at least $2 million. CON approval is also required for major medical equipment purchases of more than $1.5 million and is not a replacement for existing equipment. Mississippi is one of 35 states that requires a certificate of need.

Rhoads said that Mississippi’s CON laws were one area that policymakers could make a big change to the state’s rating. He also said that even just chipping away at some of the restrictions (such as a law that passed a few sessions ago that didn’t require CON approval for capital expenses related to natural disasters) would be a positive way to impact the state’s healthcare access.

There were three bills filed that would’ve eliminated the CON program in this year’s legislative session, but all three died in committee without making it to the floor for a vote.

Mississippi also scored lower (2.83) than the national average (3.10) on patient regulation, which is defined as easier access by patients to certain types of drugs and other patient-oriented protections.

The state was penalized for not allowing oral contraceptives unless prescribed by a physician and a lack of a free speech in medicine law. The state received top marks for protecting good Samaritans and lower taxes on e-cigarettes. 

In the payment regulation category, Mississippi received high marks for not having an individual mandate to require individuals buy health insurance, has fewer health savings account taxes, doesn’t restrict short-term, renewable health insurance plans, and allows drug manufacturer copay coupons. Mississippi received low marks for not allowing insurers in other states to issue policies in the state and its ban on reimportation of prescription drugs. 

Mississippi also received high marks for not having a lot of regulations on direct primary care plans. These plans enable doctors to bill patients directly for services. This bypasses traditional health plans, where a third party pays most of the cost while the insured pays a smaller amount. The state also received high marks for reimbursing Medicaid providers at parity for remote monitoring.

bill that would’ve kept these plans from being regulated as an insurance product by the state Department of Insurance died in the Senate without a floor vote.

Healthcare Openness and Access Project 2020: State rankings

Mississippi scored better than its neighbors overall. Louisiana had the next best overall score, ranked 30th. Alabama was ranked 35th, while Tennessee was slightly higher at 33rd. Arkansas was 40th.

New Jersey, Massachusetts and New York were the least free states overall, while Colorado, Arizona and Utah were the freest. 

The HOAP index has been released earlier than planned. The 2020 edition of the HOAP was supposed to come out in June, but the authors pushed up its release considering the coronavirus pandemic. 

This version is an early, non-peer reviewed version that was released early to help policymakers with information to remove healthcare restrictions to help fight the COVID-19 pandemic. A full, peer-reviewed version will be released later this year.