One of the principal goals of the state-run health exchanges is to allow states to somewhat level the bargaining-power playing field as their individual and small-group citizens bargain with health insurance companies. Abandoning the state-level exchange are resorting to the federal exchange throws a good deal of that bargaining power away. I can understand why state legislators who raise campaign funds from health insurers might seek to do so. But voters? False consciousness rules! Blocking a state exchange does not halt implementation of the ACA--it just gives more bargaining power to health insurance companies, and cedes some of Missouri's state governance authority to the national government in Washington.
Ann Marie Marciarille:
Missouri State of Mind: Missouri voters have apparently approved a ballot measure prohibiting the governor from using an executive order to authorize the creation of a Missouri health insurance exchange under the Affordable Care Act. Mindful that the vast majority of the eighteen states that have begun health insurance exchange formation have done so under legislative authorization but that three states are proceeding under executive order, the ballot measure is apparently designed to foreclose the latter option in Missouri.
I cannot help but be intrigued by the question of whether a ballot measure can tie the executive powers of a Constitutional elected official in this way (Art. III, Section 51 of the Missouri Constitution does specify that a ballot measure may not be used to advance an unconsitutional purpose)….
[T]oday's post is more along the lines of, "Say, how's that going to work?"
This makes it likely Missouri will be part of the federal health insurance exchange…. We know… that federal exchange development proceeds… that the federal exchange will allow all qualified plans to offer coverage in the exchange, contemplating a wide-open health insurance market. What does Missouri gain or lose from passing on the opportunity to structure and operate its own health insurance exchange?…
Missouri loses or lessens the power to influence the choice of the state benchmark plan… a choice that could be more or less sensitive to the health insurance needs and preferences of Missouri citizens… loses any authority over certifying or de-certifying participants in the health insurance exchange that will serve its citizens…. How the traditional state authority to regulate health insurance on the state level… will dovetail with the federalization of health insurance exchange operation in Missouri promises to be interesting to watch…