Legislation recently passed by the Missouri Senate and currently under consideration in the House would bypass the governor and put the implementation of a state health insurance exchange, mandated by President Obama’s law, in the hands of the voters this November.
The Republican-led House and Senate pitted themselves against Democratic Gov. Jay Nixon, who attempted to implement a health insurance exchange last year by signing an executive order to begin the process of planning for an exchange. Senate Bill 464, which passed 25-8, would make certain this doesn’t happen, according to Sen. Jane Cunningham (R-St. Louis County).
“Gov. Nixon is fighting the strongly expressed will of the voters on Obamacare with his efforts to implement a health insurance exchange. I’m surprised at that when he’s up for election,” said Cunningham.
Would Require Voter Approval
Patrick Ishmael, a policy analyst at the Show Me Institute, says the bill would require the exchange to be created solely by legislative act and would specifically prohibit implementation via executive order. If it passes the House, the law will go to the voters in November.
“Long story short, there is no exchange,” said Ishmael. “In fact, [the] legislation . . . would explicitly prohibit the governor from implementing it unilaterally.”
The legislation has been assigned to the Missouri House’s Health Insurance Committee, and received a hearing March 27th, but has not yet been sent to the House floor. On the day of the hearing, thousands of Missouri Tea Partiers rallied at the state Capitol to support steps to block the implementation of Obama’s law.
Likely to Wait for Ruling
Missouri is not the only state where the governor has used an executive order to attempt to create an exchange. In others, such as Minnesota, Rhode Island, and Indiana, governors of both parties have taken steps toward creating an exchange via executive order—in the case of Minnesota, after being rejected outright by the legislature.
Ishmael said Missouri’s legislative branch, which already opposes this aspect of ObamaCare, has little incentive to meet the January 2013 deadline of having a blueprint for an exchange in place. Should the Supreme Court rule the president’s health care reform is unconstitutional, such a plan would become moot.
“Because there’s that ambiguity, I think the legislature is going to wait to see how it turns out at the Supreme Court level,” Ishmael said.
No Thanks to Grant Money
Though federal grant money is available to states implementing a health insurance exchange, elected officials in Missouri aren’t eager to meet the requirements to receive that money, says Republican Lt. Gov. Peter Kinder.
“No instrumentality of the state can apply for or accept money for the implementation of the exchange,” Kinder said. “We are in the process of joining those states who have pretty much rejected the exchange.”
Kinder said they won’t have to worry about interference from the governor during that process.
“We raised enough of a ruckus that the governor is now in full retreat and has been quoted as saying, ‘I don’t have any plan now to move forward [with an exchange].’ He’s doing what he does best—he’s hiding,” Kinder said.
Kinder also expressed doubts the federal government will be able to implement a system for Missouri once the deadline is passed. He recalled Health and Human Services Secretary Kathleen Sebelius telling Missouri residents the federal government will be ready to implement an exchange.
“I think there’s a little matter of the November election,” Kinder said. “When [Sebelius] speaks, it’s final in her mind. The people of Missouri have something else to say about it, and their elected representatives, who are fiercely opposed to it.”
Feds Would Take Over
If Missouri does not have a plan in place for insurance exchange and the Obama administration reaches a second term, the federal government would indeed try to take over, Ishmael said.
“If the federal government does that, there is no subsidy, which means that suddenly everything is a lot more expensive,” Ishmael said. “If there is no exchange, people see exactly what the costs of this program are, assuming it gets implemented at all and the Supreme Court doesn’t throw it out.”
Ishmael said the Supreme Court case is a major factor giving Missouri legislators pause. They are concerned any steps toward implementation could hurt the argument that ObamaCare is unconstitutional.
“If you implement it, you are giving fodder to the belief that the states support this,” he said, adding, “It’s not gridlock, but it’s not proceeding at an extraordinarily rapid pace.”
‘Let Them Pay For It’
Senate Bill 464 isn’t the only Obama insurance exchange-related legislation being voted on in Missouri. The Health Care Freedom Act, passed as Proposition C last year, will once again make its way through the legislature, this time as a constitutional amendment.
Cunningham said even if Missouri developed its own exchange it would be controlled by the federal government.
“The proposal last year was not a Missouri exchange,” Cunningham said. “It was a federally dictated and directed exchange with a Missouri name on it.”
The burden of implementation, Cunningham said, should therefore fall on the federal government.
“Shoot, if the feds are going to dictate the exchange, let them pay for it,” Cunningham said.
