HHS denies Mississippi exchange

Update: Mississippi’s Department of Insurance’s spokesperson has told NU it will not apply for a state-federal health exchange partnership. Applications are due Feb. 15 for this model. It is unclear if the partnership model also requires the buy-in of the governor’s office and other state agencies. Section 3.0 Eligibility and Enrollment under PPACA makes one of the requirements of a State-Based Marketplace a coordination strategy with other agencies administering Insurance Affordability Programs and the SHOP that enable the  Exchange to carry out the eligibility and enrollment activities. 

The Department of Health and Human Services (HHS) last week rejected approval of the Mississippi insurance commissioner’s state-based exchange application, citing the opposition by the Mississippi governor as the key obstacle, a decision highlighting the divisive nature of the exchange process in some states. 

Insurance Commissioner Mike Chaney was pitted against Republican Gov. Dewey Phillip “Phil” Bryant in the struggle to implement the health exchange portion of the Patient Protection and Affordable Care Act (PPACA).

To be successfully approved and to even work as a marketplace, a state-based exchange would need working relationships with other state agencies under the requirements of a state-based marketplace under the Act. Specifically, the application must show that “the Exchange has developed and documented a coordination strategy with other agencies” administering insurance affordability programs that enable the exchange to carry out the eligibility and enrollment activities. 

With Bryant’s well-publicized refusal to work with HHS or Chaney, there was no possibility of coordinating strategy with other agencies under his authority, HHS concluded. 

“I have said repeatedly that the health insurance exchanges mandated by ObamaCare are not free-market exchanges. Instead, they are a portal to a massive and unaffordable new federal entitlement program. They trigger new taxes on businesses and will ultimately drive more people onto Medicaid rolls. I firmly maintain my position that Mississippi will not willfully implement a mechanism that will compromise our state’s financial stability,” stated Gov. Bryant in response to the decision.

“Make no mistake, the federal government will control all exchanges established under the Affordable Care Act,” Bryant stated.

Bryant is echoing the sentiments of other Republican governors, who have sometimes put their insurance commissioners in awkward positions as they try to work with HHS. Some states are feeling friction between state agencies, including the governor’s office and the insurance departments or other voter-mandated impediments.

In Kansas, where moderate Republican Insurance Commissioner Sandy Praeger chairs the state regulatory association’s health insurance committee, works well with HHS and wants some kind of exchange partnership, the governor, Sam Brownback, has been opposed to implementing the PPACA at all, including a state-based exchange.

See: Praeger seeks quick insurance exchange answer from governor

In Missouri, even with a Democratic governor, a ballot measure passed barring state officials from helping carry out a state-based exchange. In Minnesota, exchange planning was removed from state insurance department oversight by Gov. Mark Dayton.

“With a lack of support from your governor and no formal commitment to coordinate from other state agencies, we do not see a feasible pathway to conditionally approve a state-based exchange in Mississippi for 2014,” the letter from Gary Cohen, director for the Center for Consumer Information and Insurance Oversight (CCIIO) wrote to Chaney Feb. 8.