[Chaney] State ‘Model’ Health Exchange Law Dies

by Mike Chaney, Mississippi Insurance Commissioner
April 7, 2011

I would like to take a little of your time today to talk about something that has dominated national news coverage for the last several years. It has also dominated a lot of time in the Mississippi Insurance Department.

When President Obama signed the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare, last year, it set the stage for some sweeping changes in American health care. I'd like to be clear here that if I had a vote, I would not have supported PPACA.

However, one particular facet of the law deserves special attention - and that is the health care exchange. Simply put, an exchange is a website where people can compare competing health care plans and choose one they can afford that serves them best. (Think Travelocity or Orbitz as they work in the travel industry.)

A health-care exchange is not a partisan political issue. Across this nation, Republicans and Democrats alike have embraced the concept of health exchanges as a way to help individuals and small businesses more easily obtain health insurance. In fact, our own Gov. Haley Barbour has, for three years, introduced legislation in the Mississippi Legislature designed to set up an independent exchange in our state.

He did not succeed, but with the passage of PPACA, health exchanges became part of the law. And while I may not have supported PPACA, it is now the law of the land and it is my sworn duty to uphold that law unless it is repealed.

Also, PPACA specifies that in states that do not set up a health exchange, the federal government will come in and run an exchange in those states. I simply do not believe that the federal government can run something in Mississippi to benefit Mississippians better than we can ourselves. We at MID see this as a way to set up and run our own exchange, specifically geared to our state and our problems and advantages.

To that end, the Mississippi Insurance Department has dedicated hundreds of manhours studying the health care law and trying to develop programs and legislation to comply with that law.

It was a Herculean task because while the law specifies that states would have an exchange, the blueprint for how to set up and run one were not addressed in PPACA, leaving states to figure it out on their own. I'm very proud of the work done in our department to craft legislation that would allow us to set up an exchange while leaving room for adjustments to be made as the PPACA regulations become clearer.

Our staff did such a good job, in fact, that our legislation has been held out to other states as the "model exchange law" they should follow. The federal Health and Human Services Department came to Mississippi to learn about our legislation and went away impressed with how thoroughly we had met the challenge.

However, we knew the battle was not won. Health exchange bills had died in most states and in the Mississippi Legislature for three previous years, so we prepared for the legislative session as best we could. We held "learning sessions" for key legislators to show the bill to them and explain it to them line by line, knowing their understanding of what we were trying to do was crucial. We also held sessions for other stakeholders in the state such as consumer representatives, health insurance companies, rural health care advocates and health care groups.

We obtained promises of support from all stakeholders but ultimately it was not enough to overcome the politics of health care reform. Promised help failed to appear and promised support vanished.

In the end, our goal to improve healthcare for all 2.9 million Mississippians and our argument that a market-based exchange, set up outside the federal law, was good for the 2.9 million people of Mississippi and would lead to better access to health insurance for all Mississippians was not enough to ensure passage.

Some opposed the bill because they could not get their own people on the governing board of the exchange, thinking erroneously that it would lead to big money for themselves and their supporters. Some opposed the bill because they oppose PPACA overall and could not see the exchange as a separate and independent entity. Some just want to let the federal government run it.

Despite the best efforts of myself and the Mississippi Insurance Department, exchange legislation that has been hailed as model legislation, died.

I will add, however, that I will not give up in the pursuit of a market-based exchange that will make coverage available to thousands of uninsured Mississippians.

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