Late last week, a Missouri state court ruled that the Missouri Secretary of State-produced ballot measure summary on health insurance exchanges was not a fair and sufficient summary of the ballot measure submitted. The court ordered that the following ballot summary be used instead: "Shall Missouri law be amended to prohibit the Governor or any state agency, from establishing or operating state based health insurance exchanges unless authorized by a vote of the people or by the Legislature?" The ballot summary found wanting asked if "Missouri law be amended to deny individuals, families, and small businesses the ability to access affordable health care plans through a state-based health benefit exchange unless authorized by statute, initiative or referendum or through an exchange operated by the federal government as required by the federal health care act?"
What's the difference? Everything.
The rejected ballot summary emphasizes the inevitability of health insurance exchange establishment in Missouri under the ACA, explicitly noting that the federal government is prepared to establish a health insurance exchange in any state that does not establish one (with or without a vote of the people). The replacement ballot summary frames the issue in a narrower way: should anyone other than the people or the legislature retain the authority to decide to launch Missouri's health insurance exchange.
Both seem to me to be pretty accurate. They are just talking about two different things. The out-moded ballot summary about the inevitability of an exchange and hard choices about trying to shape Missouri's exchange or take what the federal government gives. The replacement ballot summary about the necessary role the state legislative process would have to play in creating the health insurance exchange. It is, in fact, this process that adds considerable time to the exchange roll out process and why any state planning on do-it-yourself exchange building will need to get legislation in place very soon.
That said, maybe turning all of this into a ballot measure is the real decision itself. By the time of the November 2012 vote, it may well be too late to launch the first and necessary exchange-building steps.
Maybe Missouri has already opted-out of a state designed and operagted health insurance exchange under the ACA.