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Mississippi commish, governor at odds over exchange

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Mississippi Insurance Commissioner Mike Chaney said in an interview today that his state department and officials at the Department of Health and Human Services (HHS) are working together to figure out how to best get an exchange approved in the state despite the governor’s resistance.

Chaney spoke with HHS officials Monday after Mississippi’s exchange approval was tabled due to the fracas between the commissioner and Republican Gov. Phil Bryant.

Chaney, also a Republican elected to office, had proposed a state-run health insurance exchange and submitted it to HHS for approval, and said he still vastly prefers the state option to a federal exchange for many reasons, but that everything is still in flux. HHS also prefers the state to have a state-run facility, he said but if it does not get the conditional approval needed, the default would be a federal partnership.

Chaney said he is still working on a way to get the exchange approved and is confident that he has the authority to do so on his side, but agreed that the wildcard was Bryant’s position.

Chaney said the governor has now said he supports a free market solution, which Chaney says is the state-based exchange option more than the federal one.

Gov. Bryant has argued that Chaney doesn’t have approval to authorize an exchange, at least without legislative and gubernatorial backing, according to press reports. And he has not gotten those.

Bryant’s position appears to be from his letters to HHS, as reported, that the federal government will really be behind a state-based exchange, and end up subsuming power, something he does not want in his state.

HHS is withholding judgment publicly in the ongoing disagreement over state authorities to oversee performance of all required exchange activities.  The agency, though, has said it will continue to work with state officials as they determine how best to resolve these issues.

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Bryant issued a screed against “Obamacare,” especially potential Medicaid expansion last July on his website, writing about his concern that the costs to be incurred by the state are an enormous burden on all other resources, such as those used for education, public safety and job creation. 

Bryant does want to support healthcare by putting funding toward the expansion of the University of Mississippi School of Medicine and incenting doctors who graduate to practice in the state and in its underserved areas. Bryant wants the doctors who graduate in Mississippi to remain in Mississippi and earlier this year signed a measure to increase the number of medical residency programs in the state.

In late October Bryant announced that the Mississippi Development Authority will award $10 million in Community Development Block Grant funds to UMMC to aid in the expansion of its School of Medicine. “Mississippi needs more physicians, and we cannot wait any longer,” he stated at the time.

Bryant’s office did not return a call by presstime. According to his Twitter feed, Bryant was at the ground-breaking ceremony for the School of Medicine expansion. 

Chaney took office in 2008 and is heavily involved in the wind mitigation program for the Mississippi Gulf Coast region to strengthen homes against hurricane-force winds, and flood issues and homeowners’ issues, and chairs the NAIC’s Property and Casualty “C” Committee.

Eighteen states and the District of Columbia are hoping to run a state-run exchange in 2014. In addition to the District of Columbia, those jurisdictions are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Utah and Washington, Sara Collins and Tracy Garber of the Commonwealth Fund reported last month.

States that want to run their own exchanges were supposed to let HHS know by Dec. 14, and Mississippi had done so and was up for conditional approval with its like-minded states when the flap with the governor occurred. States have until Feb. 15, 2013 to choose a state partnership exchange.

States have more time to say whether they will run partnership exchanges. The states that appear to be planning to operate partnership exchanges are Arkansas, Delaware, Illinois, Iowa, North Carolina and West Virginia, according to Collins and Garber.