This article first appeared in the St. Louis Beacon, Sept. 19, 2011 - The federal health-insurance changes slated to go into effect over the next two years aren't part of the Missouri General Assembly's special session now underway.
But one wouldn't know it from the fury coming from several Republican legislators and senators, who accused Gov. Jay Nixon late last week of trying to skirt legislative approval as his administration prepares for the state-run (or federally run) health-insurance exchange that's supposed to be approved by the federal government by 2013, and in place a year later.
Nixon's administration denies taking any such action.
But state House Majority Leader Tim Jones, R-Eureka, says the furor could well influence the rest of the special session.
Beyond the short-term impact on the special session, Jones added, "I think it's going to have some long-term effects."
State Sen. Jane Cunningham, R-Chesterfield, announced late Friday that she plans to sponsor a proposed constitutional amendment when the next regular session convenes in January. That amendment would bolster the legal standing of Proposition C -- which passed overwhelmingly in August 2010 -- which seeks to bar enforcement in Missouri of the federal mandate that most people purchase health insurance by 2014.
Such a move by Cunningham would resurrect Proposition C as a constitutional amendment on the 2012 ballot -- which could help draw conservative voters to the polls.
Cunningham contended in a statement that state officials with Nixon's Department of Insurance and the board of the Missouri Health Insurance Pool acted improperly last week and appeared to be trying to outmaneuver the legislature.
Cunningham was among several senators who showed up last Thursday right before the health insurance board planned to vote to accept $21 million in federal money. The grant was to help the state begin implementation of the federal requirement that Missouri set up up a health-insurance exchange by 2014.
With an exchange, any Missourian or small business (50 employees or less) is supposed to be able to shop for health insurance and purchase it cheaper than now available on the open market.
States are to receive subsidies to help set up the exchange, while the public also will qualify for subsidies, depending on income. The subsidies will be available for people earning up to four times the federal poverty guideline, which now is $10,890 a year for an individual.
Missouri Department of Insurance director John Huff said in an interview that the federal grant is to be used for "technical planning and groundwork'' should the General Assembly vote next session to set up an exchange.
Huff said that his department had announced in June that it planned to apply for the grant, which was awarded Aug. 12. The state has to move quickly, he said, because it is supposed to have a federally approved exchange by January 2013.
Amid last Thursday's confrontation, the health-insurance board opted to delay a vote on the $21 million grant, which Huff says remains available. "I think there was some confusion" among legislators about what the grant is for, he added.
Huff emphasized that the formal decisions to set up the exchange are to be made by the General Assembly and that Nixon has no plans to issue an executive order.
As the federal law now stands, if Missouri fails to set up an insurance exchange by 2013, the federal government will set up one in its place. Several states around the country oppose the plan and are trying to opt out of the insurance-exchange program.
Exchange supporters contend that the rising resistance among Missouri Republican legislators could be tied to an announcement earlier this summer by the American Legislative Exchange Council, a conservative legislative group, that it now opposes health insurance exchanges.
Cunningham is among a number of Missouri legislators who have been active in ALEC.
General Assembly May Oppose Setting Up exchange
The Missouri House voted overwhelmingly last session to set up an exchange, out of fear that failure to do so would result in a federal exchange that offered insurance to cover certain procedures -- such as abortions -- that legislators would oppose. Jones was among those who voted in favor of the exchange, for just those reasons.
(That bill, HB 609, had a provision saying it would be automatically repealed if the courts toss out the federal health-insurance requirements.)
Even so, the state Senate balked. Cunningham said last spring that the exchanges needed to be studied more thoroughly. She is a member of the Senate Interim Committee on Health Insurance Exchanges, which has been holding meetings around the state. A session has yet to be held in the St. Louis area.
Jones, who is slated to become House speaker in 2013, said in an interview that a move is now afoot in the legislature to oppose any sort of state exchange -- even though a majority had backed it earlier this year.
Opponents of a government-run plan, he said, seek to "poke a stick in the eye of Obamacare."
As Jones sees it, the General Assembly could -- and, very well, may -- opt against setting up a health-insurance exchange during the next legislative session. He added that Republican legislative leaders will also pressure Nixon, a Democrat up for re-election in 2012, not to take any sort of action to set up an exchange.
"If the governor and the legislature do not act...that's giving us a waiver from Obamacare,'' Jones said.
What about the small businesses or individuals who want an insurance exchange? Jones said it is his understanding that "the (insurance) industry could set up a private exchange."
Huff said he's heard no talk from any quarters about any sort of private exchange. And private exchanges would not be eligible for federal subsidies to reduce coverage costs, he said.
Huff noted that the federal health-care law will dramatically increase Missouri's Medicaid rolls by raising eligibility standards. As it stands, low-income adults in Missouri can earn no more than 19 percent of the federal poverty level qualify for Medicaid. That means those people can earn no more than $2,069 a year.
Under the federal regulations to be put in place by 2014, people earning up to 138 percent of the poverty level -- or, $15,028 a year in 2011 dollars -- would be eligible for Medicaid.
The subsidy for the health exchanges, said Huff, will be for people earning from 139 percent of the federal poverty guideline to 400 percent.
Those requirements may change, he added, if Congress changes the law or the courts toss some or all of it out.
In any event, Huff emphasized that he was simply providing information and that the decisions regarding health exchanges will be up to the General Assembly.
Again, the matter officially isn't on the special-session agenda.
But expect plenty of talk about it.
