Immediately after the presidential election, Missouri Governor Jay Nixon announced the state would not be setting up its own health insurance exchange.
Next door in Kansas, Governor Sam Brownback made a similar announcement. Exchanges are online market places where people will soon go, to compare and shop for health insurance. The federal health law requires all states have them up and running by January first of 2014, as part of the law’s attempt to make health insurance more accessible. Kansas and Missouri’s recent decisions to stay out of it, for now, mean the federal government will likely come in and manage the exchanges instead.
GORDON: President Barack Obama’s health law has never had any easy time in Kansas or Missouri. And it’s still not going down very well. Kansas Governor Sam Brownback, a staunch opponent of the law, announced a few days after the election, that Kansas would not have any involvement in setting up or managing a health exchange. Sherriene Jones-Sontag is a spokesperson for Brownback’s office:
JONES-SONTAG: Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in this federal program.
GORDON: Across the state line in Missouri, the law has also faced an uphill battle. Voters approved a measure on Election Day, which prohibits the governor or any state agency from making any moves toward setting up an exchange without legislative approval. And, lawmakers don’t convene again until January, well past some of the key deadlines for setting up an exchange. Governor Jay Nixon, a democrat, has said all of this means that at least for now, Missouri will have a federal exchange.
NIXON: Based on current state law and the federal deadline, the state based option isn’t on the table for Missouri at this time.
GORDON: Some health policy experts find the situation in the region ironic. Thomas McAuliffe is with the Missouri Foundation for Health, which has helped fund efforts to plan an exchange.
MCAULIFFE: We have a state that is very much committed to state’s rights and state control, yet we’re willing to just blindly cede all creation and administration of a health-based exchange or insurance state marketplace to the federal government.
GORDON: But McAuliffe doesn’t want to write everything off just yet. He thinks states like Missouri may change course, once the political dust settles. Governor Nixon himself said in his announcement earlier that falling back on a federal exchange isn’t ideal.
NIXON: Regulating the insurance market is a power best left in the hands of the states, where we perform those duties more efficiently and effectively, and provide better service for our consumers.
GORDON: Early on, Missouri had made some progress toward setting up an exchange, as had Kansas. That came to a halt in both states. The governors were supposed to then tell Health and Human Services by last week whether they or the federal government would be setting up and managing their exchanges. But the federal agency changed course, giving states more time to submit their plan, and even more time to decide whether they’d want to partner with the federal government. Brownback has reaffirmed Kansas won’t be involved, but there are still those like Kansas insurance commissioner, Sandy Praeger, who want the state to have a role. Praeger says that will depend on the path Governor Brownback takes with his new legislature in the months ahead.
PRAEGER: His concern is that they have all these new conservative Republicans that won’t want to go along with a partnership exchange, but I just – I’m still hopeful. I’m still hopeful.
GORDON: But lawmakers may raise several concerns about getting involved. Frank Ellis is past chair of the greater Kansas City Chamber of Commerce.
ELLIS: You can look at it from the standpoint of, state elected officials on both sides of the state line do not want to take on another liability, another bureaucracy [that will have associated budget costs], and they see that coming.
GORDON: Ellis heads Swope Community Enterprises, which includes Swope Health Services, a local community health center that operates on both sides of the state line. He says patients, businesses, insurers, health providers – everyone has skin in the game. And he worries about a lack of state and regional involvement.
ELLIS: If the feds come in, they’re not going to have a different model per say for each community. They’re going to standardize one shoe fits all, and the health care needs in Missouri and Kansas are far different than the health care needs in New York and Maine, or in Arizona.
GORDON: Meanwhile, the Missouri Foundation for health’s, Thomas McAuliffe, says by extending the deadline for states to declare whether they will run an exchange or not, the federal department of Health and Human Services is signaling a bit of desperation.
MCAULIFFE: This is an indication to me that Health and Human services, ie: the Obama administration, is dying for state support on this. Their worst case scenario is that they set up nearly 30 federal based exchanges.
GORDON: And what that means, he says, is that states like Kansas and Missouri will still have an opportunity in the future to get more involved if they choose to. But Missouri’s Lieutenant Governor, Peter Kinder, who has supported legal challenges to the law, thinks these extensions are a sign of the health law’s weakness and future demise.
KINDER: They are effectively admitting failure. I do not believe the federal government is going to have the money to for the exchanges. And so the threat that they’re leveling against us is that if we don’t do a state level exchange, they will do our exchange for us. And I’m prepared to call that bluff. I don’t think they’ll do it.
GORDON: With the elections behind them, leading Republican lawmakers in Missouri have started meeting again, and discussing whether the state should get involved in an exchange. Kinder thinks the majority will want to stay out of it, but many still want more details about how a state exchange would operate differently from a federal one. What the state decides to do down the road is not the chief concern for those in the health care industry, like Matt All. All is the top lawyer with Blue Cross and Blue Shield of Kansas, the largest company in the state. He says the reality is all these exchanges have to be up and running in a little over a year.
ALL: I don’t want say it’s going to be a rushed process, but we are going to have to work very intensely over the next several months to get ready. We just don’t have time to spend worrying about the politics of it, to worry about regretting a decision or hoping for another decision. We just need to get started.
GORDON: All says in order to get started, he and others need more direction from the feds on how the exchange will work, now that they’ll be taking the lead in the region. That includes more guidance on what the actual insurance products are supposed to look like on the exchange and how they’ll be sold. And, with a start date of January 1, 2014, for when residents and small businesses will start accessing insurance on those exchanges, that’s not a lot of time for either federal leaders or the health care industry to work out the details and make sure everything’s ready.
This story is part of a reporting partnership that includes KCUR , NPR and Kaiser Health News.
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