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Rupp urges lawmakers to put health exchange on back burner

This article first appeared in the St. Louis Beacon, Dec. 20, 2011 - State Sen. Scott Rupp, R-St. Charles, says Missouri lawmakers should take no action on any insurance exchanges until the U.S. Supreme Court rules on the legality of the health-reform law under which exchanges are being created.

His push for no action in the next legislative session may surprise some since Missouri is under pressure to meet a federal deadline for building a state-created exchange. But his view is in line with other area GOP senators, including Jane Cunningham of Chesterfield and Jim Lembke of Lemay. Democrats decry any delay and argue that Missouri should develop a consumer-friendly health insurance exchange even if the court voids the federal Affordable Care Act.

Start of update: Rupp's views are important because he headed the Senate Interim Committee on Health Insurance Exchanges. It was charged with looking at the state's options in setting up an exchange and the impact of an exchange on state law. He said public testimony from the hearings would be offered to Senate colleagues. The panel issued no report, but his comments since the hearings offered a clue of the advice he would offer colleagues on how to proceed on the issue. End of update.

Rupp acknowledges that inaction would put Missouri under a tighter deadline. Each state is required to demonstrate its ability by Jan. 1, 2013, to operate an exchange; by the third quarter of 2013, a state is supposed to start enrolling members into its exchange; by the start of 2014, all provisions of the law are supposed to be up and running. States that miss the deadlines for setting up exchanges will have to settle for an exchange created by the federal government.

"In my opinion, there's nothing that's going to get done in the Legislature (next year), especially since the Supreme Court is going to take up that issue," Rupp says, adding that he's speaking only for himself.

"Rather than spin the wheels and spend time debating on the floor something that's not going to happen, the plan of action is to wait to see what the Supreme Court does."

If the court upholds the health reform, state legislators will have to decide if they want to create an exchange, and the question could be resolved in a special legislative session, Rupp says.

Delays Cost Money

Legislative inaction already has kept Missouri from accepting $21 million in federal money to get moving on an exchange. The delay is a big concern among some members of the MO HealthNet Oversight Committee, which offers the state guidance on Medicaid. The panel wants to get Medicaid ready for the exchanges. Part of the federal dollars on hold would be used for information technology to run the exchange and also help update Medicaid information technology. Because so much is at stake, the oversight panel recently took the unusual step of urging state lawmakers to act.

The federal funds are being funneled into a quasi-government organization, the Missouri Health Insurance Pool. Some GOP lawmakers are raising issues about accountability. Echoing the views of some other Senate Republicans, Rupp accuses members of the executive branch of "trying to do an end run around the legislature and put the framework together for their own exchange."

But many Senate Democrats see the matter differently. One is state Sen. Joe Keaveny, D-St. Louis, who was on the committee that conducted statewide public hearings on insurance exchanges. He says the issue for some Republicans is less about accountability than about undermining a policy linked to a law they dislike.

"They want no more government intervention," he says. "Quite frankly, they are doing everything (to block the health-reform law). They don't want to buy into this plan because they don't want this to be interpreted as an endorsement of the Affordable Care Act."

Exchanges and Competition

Keaveny says that an exchange is needed in Missouri, regardless of what the court decides, because it would bring more transparency to buying health insurance and would lower cost.

"I am pushing for a state-sponsored exchange. I think we need it. I think, unfortunately, some of my colleagues are allowing politics to get in front of good public policy. How can we take a position where we eliminate competition? All an exchange does is give residents of this state an opportunity to utilize robust competition in a very complicated market."

Some experts agree. Sidney D. Watson, a law professor at Saint Louis University, wonders why there is so much dissent over what she sees as a simple, consumer-friendly approach to buying health insurance. To help the public understand how the system might work, she points to federal exchange set up to help seniors buy supplemental Medicare benefits through Medicare Advantage Plans and the Medicare Part D prescription drug plan.

Each year, Medicare members in Missouri have access to a Medigap shopping guide that allows them to compare rates and benefits when shopping for a Medicare supplement for either health benefits or drugs.

Missouri's guide is issued by the Department of Insurance. Consumers with questions can call CLAIM -- Community Leaders Assisting the Insured of Missouri. Anecdotal information supplied by state officials suggests seniors like free expert help. Some reportedly saved hundreds of dollars a month on Medicare services and prescriptions because the guide made it easier to compare benefits offered by different insurers.

Rupp held hearings in Columbia, Kansas City, Springfield and St. Charles. Watson was among those who testified during the St. Charles session. She urged lawmakers not to miss the opportunity for Missouri to set up its own insurance exchange. That would permit Missouri to design a plan that does the best job in meeting the needs of Missourians.

Keaveny made a similar comment, saying, "If we don't do it, the federal government will do it for us."

That argument had spurred bipartisan House support for an insurance exchange bill. But it fell apart when the legislation moved to the Senate.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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