Analyst: Missouri law to snarl PPACA exchange

Bridge Kevin-Myers Bridge Kevin-Myers

A Missouri health insurance exchange development law could have a big effect on efforts by the U.S. Department of Health and Human Services (HHS) to provide exchange services for Show Me State residents.

Bridget Kevin-Myers, an analyst at the University of Missouri, gives that assessment in an analysis of a Missouri ballot measure based on state Senate Bill 464.

Voters approved the ballot measure in November 2012.

The federal Patient Protection and Affordable Care Act of 2010 (PPACA) requires HHS to set up health insurance exchanges -- Web-based health insurance markets -- for the residents of states in which state agencies are unable or unwilling to set up state-organized exchanges.

The law created by the Missouri anti-exchange ballot measure prohibits any state agency, department, instrumentality or political subdivision from moving without the approval of the state general assembly to set up a state-based PPACA exchange.

The anti-exchange law also prohibits Missouri agencies and officials from moving without general assembly approval to help HHS or any other federal agency set up or run a federal PPACA exchange.

The law gives any taxpayer or member of the state general assembly standing to sue the state to block efforts to help set up a state or federal PPACA exchange.

HHS requires states that want to run or help run PPACA exchanges to notify it of their interest by Feb. 15, Kevin-Myers said.

Because the deadline is so close, even if the general assembly approved efforts to help with exchange development, "there is essentially no chance that a federal-state partnership exchange will be operational by October 2013," Kevin-Myers said. "Consequently, Missourians ceded control to the federal government to operate a health insurance exchange, at least for the time being."

Missouri insurance regulators would be responsible for regulation on insurance products sold through a federal exchange in Missouri, Kevin-Myers said. 

If Missouri insurance regulators decline to approve any exchange health insurance plans because of concerns about the anti-exchange law, it's not clear what plans an HHS exchange will be able to sell in Missouri, Kevin-Myers said.

In the long run, opponents of the law probably will challenge the law in court, and that could lead to costly litigation, Kevin-Myers said.

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