All states are required under President Obama’s health care law to create a state health insurance exchange by 2014. Yet despite initially embracing the idea, Missouri’s legislature ended this year’s legislative session without passing a bill to create an exchange.
A bill called the Show-Me Health Insurance Exchange Act was introduced late in the session, passing the House by a unanimous 157 to 0. It stalled, however, upon reaching the Senate.
Cunningham Blocked Bill
One key reason was the opposition of State Sen. Jane Cunningham (R-West County), who fought against the Act when it was introduced in her chamber.
“There were several reasons why we I decided to fight the Show-Me Health Exchange Act,” explains Cunningham. “Missouri was the first state to pass the Health Care Freedom Act, Prop C, by 71 percent of our voting population, giving the first [state] rejection of Obamacare in the nation. So it was important to me that we not put something in the law that would conflict with Prop C, which protected Missourians against the individual mandate of Obamacare.”
The Act would have created a quasi-public agency, run by a 17-member board, tasked with helping individuals and small businesses in buying health plans.
Cunningham explains the exchange bill, House Bill 609, would have intruded into citizens’ privacy by requiring individuals get a waiver in order to be exempted from the individual mandate.
“I also feel like it conflicted with the efforts of our Attorney General, Chris Koster, who filed an amicus brief in the Florida lawsuit with more than half of the other states,” Cunningham said. “I worried that it conflicted with the protection from the individual mandate, and could cause a problem with that lawsuit.”
Lessons for Other States
Although other states are pursuing exchanges, Cunningham maintains it is impossible to create a true state-focused exchange under HHS regulations.
“Throughout the bill it references the federal code that we would have to align with and it gave tremendous powers over our exchanges to the [U.S.] Secretary of Health and Human Services,” Cunningham said. “I had a hard time seeing that this was a Missouri exchange, because if you read it, it was really a federal exchange.”
As for other states, Cunningham says they ought to consider the timeframe, and whether pushing an exchange forward is necessary.
“We did not have create an exchange this year, so it did not seem prudent for us to pass a law in the middle of all this confusion while not knowing what we are going to do,” said Cunningham.
Sarah McIntosh, Esq. ([email protected]) is a constitutional scholar writing from Lawrence, Kansas.