Updated: 12 February 2013, 1:11 pm EST
Econintersect: The U.S. Department of Health and Human Services (HHS) has rejected an application for a state-based health insurance exchange for Mississippi under the PPACA (Patient Protection and Affordable Care Act, aka Obamacare). The application was submitted by the state Insurance Commissioner, Republican Mike Chaney. It was opposed by the Republican governor Dewey Phillip Bryant. HHS cited the opposition of the governor as the reason for the rejection.
According to LifeHealthPro:
To be successfully approved and to even work as a marketplace, a state-based exchange would need working relationships with other state agencies under the requirements of a state-based marketplace under the Act. Specifically, the application must show that “the Exchange has developed and documented a coordination strategy with other agencies” administering insurance affordability programs that enable the exchange to carry out the eligibility and enrollment activities.
With Bryant’s well-publicized refusal to work with HHS or Chaney, there was no possibility of coordinating strategy with other agencies under his authority, HHS concluded.
One might think that the actions of the governor would be along the lines of "I don't like the game you are playing so I will take my bat and ball and go home." However, by U.S. law there will be insurance exchanges available in Mississippi because PPACA requires them to be set up by the federal government for all states not establishing their own exchanges.
What Gov. Bryant is doing is to abrogate any state input or control of health insurance exchanges to the federal government. Such is the state of mind of some who feel Washington exercises too much control.
Here is Bryant's reasoning (LifeHealthPro):
“I have said repeatedly that the health insurance exchanges mandated by ObamaCare are not free-market exchanges. Instead, they are a portal to a massive and unaffordable new federal entitlement program. They trigger new taxes on businesses and will ultimately drive more people onto Medicaid rolls. I firmly maintain my position that Mississippi will not willfully implement a mechanism that will compromise our state’s financial stability,” stated Gov. Bryant in response to the decision.
“Make no mistake, the federal government will control all exchanges established under the Affordable Care Act,” Bryant stated.
Similar situations exist in other states. In Kansas Republican Governor Sam Brownback is opposing Republican state Insurance Commissioner Sandy Praeger (Kansas Health Institute).
In Missouri a ballot initiative was passed in November that prohibits state officials from helping carry out a state-based health insurance exchange, according to HealthLifePro.
For states like Mississippi and Kansas the possibility remains that ther may be some kind of state-federal partnership developed that will establish and run state-based exchanges. That is not possible under the new Missouri law.
Some states, maybe up to half, could end up with federally run insurance exchanges, according to a report by GEI News last week.
Update 12 February 1:11 pm EST: North Carolina has joined the ranks of states with Republican governors opposing extension of Medicaid and implementing a state run insurance exchange. Today an article in the Raleigh News&Observer said:
Gov. Pat McCrory doesn’t think the state is ready to expand Medicaid or ready to run its own health exchanges – two provisions of the Affordable Care Act.
McCrory’s office made the announcement Tuesday morning just hours before the state House is supposed to take up a bill that would bar the state from participating in those two actions. The Senate passed the bill last week.
In 2011 and 2012 North Carolina had a divided government with a Democrat in the governor's office and the Republicans controlling both houses of the state legislature. The previous governor, Bev Perdue, who did not stand for reelection, had supported implementation of the optional parts of PPACA but the legislature had not.
Again, from the News&Observer:
Republican lawmakers did not pass needed legislation to set up the exchanges in the last session.
A bill that would have helped set up the exchange passed the House but was not taken up in the Senate. Senate President Pro Tem Phil Berger said at the time that he wanted to wait and see whether the Supreme Court upheld the Affordable Care Act.
Before former Gov. Bev Perdue left office, she took the first step toward the creation of a state-federal exchange partnership that would give North Carolina some oversight flexibility.
The state received a $74 million grant from the federal government to help establish the exchange. The legislation would require the state Insurance Department to return the money.
- HHS denies Mississippi exchange (Elizabeth Festa, LifeHealthPro, 11 February 2013)
- Praeger seeks quick insurance exchange answer from governor (Jim McLean, Kansas Health Institute, 07 November, 2012)
- CBO: Obamacare Coverage Estimates Shrink (GEI News, 07 February, 2013)
- McCrory says state not ready for Medicaid expansion (Mary Cornatzer, Raleigh News&Observer, 12 February 2013)