Amid news that several conservative states are getting on board with PPACA’s state health insurance exchange provision, Mississippi has recently offered its own state exchange plan to the federal government for approval, only to be shot down. The reason? Mississippi’s plan does not address Medicare, just private insurance. That is a deal breaker for the feds, and it highlights a split on this issue between Mississippi’s state insurance commissioner Mike Chaney and its governor (who opposes exchanges), Phil Bryant. But it also has left Commissioner Chaney feeling like the state came to the feds with a good faith effort and were turned aside anyway, which could hinder any effort by Mississippi to keep trying.

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