How a good health insurance exchange plan jumped the track in Missouri
A big piece of the new federal health care reform law is the creation of statewide insurance exchanges — marketplaces in which consumers can compare and purchase private plans that have been vetted for consumer protections.
The Affordable Care Act calls for the exchanges to come on line in 2014. States can either create their own or wait for the federal government to design one for them. Missouri doesn’t take well to having Washington tell it what to do.
So Republican House Speaker Steve Tilley sensibly assigned a committee to write a bill creating a state exchange.
Chaired by Chris Molendorp, a Cass County Republican, the committee all but moved mountains. Its bill received the blessing of health insurers, consumer advocates, hospitals and doctors groups and insurance agents.
The proposed legislation creates a quasi-public agency with a 17-member board. Its purpose is to assist individual consumers and small employers with the purchase of qualified health and dental plans. The bill calls for a toll-free hotline, enrollment periods, a Web site that provides easily understandable information about available plans and an electronic calculator that shows consumers how much a particular plan would cost them.
Regardless of one’s opinion about federal health care reform, exchanges are a good idea. They provide transparency and empower individual consumers and small businesses with the bargaining clout now enjoyed mostly by larger employers.
The Missouri House passed the “Show-Me Health Insurance Exchange Act” by a vote of 157 to 0. It looked like smooth sailing all the way to the governor’s desk.
But a funny thing happened on the way to the Senate floor. Sen. Jane Cunningham, a Republican from Chesterfield, got a look at the bill. She wasn’t pleased.
Cunningham was the driving force behind the “Health Care Freedom Act,” the 2010 ballot proposition that creates a statute prohibiting governments from forcing individuals and businesses to purchase health insurance, as required by the federal Affordable Care Act. The way Cunningham saw it, the insurance exchange bill violated the Health Care Freedom Act and Missouri’s very sovereignty.
“What constitutional authority does Kathleen Sebelius have to come into our state and say, ‘you have to set up an exchange?’” Cunningham asked, referring to the former Kansas governor and now secretary of the U.S. Department of Health and Human Services. Plenty, actually. The federal government requires states to do many things, usually with the threat of states losing a portion of funding if they don’t comply.
But no matter. A couple of other senators joined Cunningham’s cause, and the Show-Me Health Insurance Exchange Act never come up for a vote on the Senate floor.
Missouri has another year to create an exchange, but right now the prospects don’t look bright. “That same language will never fly,” Cunningham proclaimed. But the language she rejects is what the parties with the most stake in the exchange have agreed upon.
While Missouri’s exchange is temporarily derailed, Kansas is moving forward.
State officials applied for, and received, a $31 million federal “innovator” grant to build the technological base needed to make the exchange work.
Gov. Sam Brownback, though a strident opponent of the Affordable Care Act, supports the general idea of an insurance marketplace.
The Kansas Legislature is expected to draft a bill creating a statewide exchange in 2012. Although fewer than a dozen states have passed laws creating exchanges so far, most, like Kansas, are moving forward. It’s the pragmatic thing to do. The portion of the Affordable Care Act requiring people to purchase insurance is being challenged in court, but few knowledgeable people expect the entire law to be overturned.
Missouri’s legislative leaders face the tough job of convincing Cunningham and others to set aside their ideological biases and allow an insurance exchange that works for Missouri. Either that, or learn to like whatever Washington comes up with.
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