“Make no mistake,” Mississippi Gov. Phil Bryant declared last week upon hearing that the feds would reject his state’s plan to create its own clearinghouse for health insurance. “The federal government will control all exchanges established under the Affordable Care Act.”
Never mind that the feds have now cleared 17 states to run their own exchanges under Obamacare, and that Mississippi is the first state to get a rejection. The deeper irony is that Bryant actively undercut his own state’s bid for autonomy.
Under the Affordable Care Act, every state has until the end of this year to set up an insurance exchange where legal residents can shop for health coverage. The goal is to help consumers shop for value while forcing insurers to compete in an open marketplace. To make coverage more affordable, the act requires everyone to join the risk pool―and it subsidizes coverage for those who can’t pay full fare. To give states the greatest possible flexibility, the law offers gives them three ways to develop their exchanges. A state can (1) set up an independent exchange that meets national standards, (2) develop an exchange in partnership with the federal government, or (3) stand aside and let the feds handle the job.
For all their resistance to Obamacare, Mississippi politicians have long favored the first option. With the support of former Gov. Haley Barbour, Mississippi’s Republican insurance commissioner, Mike Chaney, started developing an exchange called “One, Mississippi” before Congress even passed the Affordable Care Act. Since the act took effect three years ago, Chaney has won a federal grant to complete the plan and has even started promoting “One, Mississippi” online as “an easy-to-use, easy-to-understand marketplace for comprehensive medical insurance, where individuals and small businesses can comparison shop for health benefits.”
But unlike his predecessor, Phil Bryant has worked to kill “One, Mississippi” in the cradle. To meet federal standards, state insurance exchanges must link consumers not only to private insurance plans but also to safety net programs―Medicaid for the poor and federally discounted private policies for people earning up to 400% of the federal poverty level. Medicaid falls under the governor’s jurisdiction, so Bryant simply refused to link the program to the “One Mississippi” exchange. Besides cutting the neediest people out of the exchange, his ploy flouted national law, forcing federal officials to reject the whole proposal. “With a lack of support from your Governor and no formal commitment to coordinate from other State agencies,” HHS wrote in in a letter to the insurance commissioner last week, “we do not see a feasible pathway to conditionally approving a State-based Exchange in Mississippi for 2014.”
One way or another, Mississippi residents will get an insurance exchange, and it won’t open a minute too soon. The state is the sickest in the country by many measures, and more than a fourth of its adults are still uninsured. In rejecting Mississippi’s proposal, HHS encouraged the state to stay engaged, but Chaney is now siding with the governor. “Mississippi does not plan on a partnership,” he tells us through a spokeswoman. Instead, the state will stick to helping employers find the best bargains through an exchange that includes only private plans, and they’ll let federal agencies worry about everyone else. When the state’s half-million uninsured residents start gaining more options next year, they’ll have the feds to thank for circumventing their governor.
Geoffrey Cowley