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Feds will set up Missouri's health-care exchange, says Nixon

This rtic;e first appeared in the St. Louis Beacon, Nov. 8, 2012 - Gov. Jay Nixon says Missouri effectively ran out of time to implement a state-based health insurance exchange, adding that the federal government would soon step in to design the program.

Fresh off his decisive re-election victory, Nixon told reporters Thursday at his office in Jefferson City that Missouri had run out of options to implement a health-care exchange, one of the provisions of the federal Affordable Care Act. The law encourages states to set up  exchanges to help provide affordable health insurance.

The idea behind an exchange is to offer a way where people without group insurance can purchase insurance at group-insurance prices on the internet.

Under the law, the federal government sets up the exchange if the state doesn't act. Because the legislature hadn’t acted, and Proposition E prevents him from issuing an executive order, the state won't make a Nov. 16 deadline, said Nixon.

Proposition E, approved by voters on Tuesday, bars the creation of a state exchange without approval of the General Assembly, or a public vote.

“Based on the constraints of federal law and the quickly approaching federal deadline, the only option for Missouri at this time is to indicate that we will be unable to proceed with the state-based exchange – absent a change in circumstances,” Nixon said. “So let me be clear: A federally facilitated exchange is not the ideal approach. Regulating the insurance market is a power best left in the hands of the states. We can perform those duties more efficiently and effectively and provide better service for consumers.

“But based on current state law and the federal deadline, the state-based option isn’t on the table for Missouri at this time,” he concluded.

Nixon noted that back in 2011, the Missouri House and a Senate committee unanimously approved legislation establishing Missouri's exchange. But the measure got stalled in the Senate.

Some Republican legislative leaders had opposed action to approve a state exchange earlier this year, saying they hoped that President Barack Obama would lose re-election and that Congress would then rescind the Affordable Care Act, also known as Obamacare.

In an interview earlier this week the Beacon, House Speaker Tim Jones, R-Eureka, said he had asked some legislators to look at whether the federal government could unilaterally implement the exchange or if there was a way to block it.

Jones said the state should resist any sort of exchange, saying he wasn't convinced it would lower insurance rates.

He also viewed last Tuesday's vote on Proposition E as a vote against the ACA. Jones also cited the 2010 approval of Proposition C, which sought to exempt Missouri from the ACA's requirement that most Americans purchase insurance by 2014.

"Jay Nixon owes it to the people of Missouri to request a waiver, like many other governors have,” Jones said.

“If he doesn't do that, if the federal government comes in and actually tries to set up some mechanism to set up an exchange," Jones said he would like the legislature to play a role and "make it as free-market of an exchange as possible."

"I'm not convinced that we're going to be forced to do it," Jones said. "I don't know what the enforcement mechanism is – if they send in troops or what.”

Jones conceded that with Obama's re-election, "Obamacare will live on, at least another four years."

But Nixon bristled at the possibility of seeking a waiver.

“When you say the law allows you to seek a waiver, seeking a waiver is saying you don’t want to follow the law,” Nixon said. “They don’t pass laws that say ‘all right, if you don’t like our laws, ask us not to apply our laws.' I mean, we’re past the times of syllogisms. It’s the law. The public passed a proposition at the ballot last week. And that’s the law. It’s unfortunately not an answer when Nov. 16 comes and goes to say not to enforce the law. That’s just the way it is.”

When asked if the legislature made a mistake of not pushing through a state-based exchange, Nixon said, “Clearly I thought the best way to move forward was to keep the state in charge as much as we possibly could. I continue to believe that government run at a state level is just a better way to do it.”

(UPDATE) The Missouri chapter of Americans for Prosperity, a conservative group, lauded Nixon's decision -- but then called on the General Assembly to vote to block any sort of state exchange. But as Nixon points out, legislators don't reconvene until January, after the federal deadline.

“The taxpayers have stood up for fiscal responsibility and health care freedom by passing proposition E, effectively rejecting the Obama Administration’s request to set up a state-based health insurance exchange,” explained Patrick Werner, state director of AFP-MO. “Exchanges raise prices on consumers and increase taxes on hardworking families. The legislature should pass legislation to permanently block a state-based exchange.” (End of update)

Nixon and the legislature

Nixon also announced that Department of Health and Senior Services director Margaret Donnelly would be leaving his administration. Donnelly – a former state representative from Richmond Heights – told reporters she would be taking a position at the St. Louis University Law School.

The governor also said that he would pursue an initiative to make state government more efficient.

Nixon was questioned repeatedly how he would govern now that both the Missouri House and Senate have enough Republicans to override his veto. After Tuesday's election, Republicans hold a 24-10 majority in the Missouri Senate and a 110-53 edge in the Missouri Hosue.

Nixon flatly said GOP majorities in the legislature would not change how he deals with the legislative process.

“The great thing about being governor is that every politician that you see, you can start the discussion by saying ‘all of your constituents are my constituents,” he said. “I’m not dividing the state and leaving out certain sections. I don’t divide the state by Democrat or Republican or by urban or rural. I divide it very simply by what’s most important for the state and what I can do to move folks along. And I’m certainly not going to begin as I start a second term here trying to dividing everything by two groups, no matter what the percentages are.

“That’s not the analysis I bring to this job – it simply is not,” he added.

Barring any dramatic change, Nixon will likely serve all eight years of his governorship with a Republican General Assembly. When asked if that’s restricted what he wanted to do, Nixon said, “I don’t look at this state in a partisan way and I certainly don’t look at my duties in a partisan way.

“I am not going to give folks a pass on working together and making progress just because they say that their party feels this way or that way,” Nixon said. “The clock is ticking. I mean, I have four more years to be governor of the state. There’s a lot more to be done.”

He also pointed out that some Republicans in suburban part of the states tend to be “far more left on the spectrum” than rural Democrats.

“This is a microcosm of the entire country,” Nixon said. “I just am not going to take the easy way out in the sense that if we get something done, it’s one party. Or if we don’t get something done, it’s the other party.”

Jason is the politics correspondent for St. Louis Public Radio.
Jo Mannies has been covering Missouri politics and government for almost four decades, much of that time as a reporter and columnist at the St. Louis Post-Dispatch. She was the first woman to cover St. Louis City Hall, was the newspaper’s second woman sportswriter in its history, and spent four years in the Post-Dispatch Washington Bureau. She joined the St. Louis Beacon in 2009. She has won several local, regional and national awards, and has covered every president since Jimmy Carter. She scared fellow first-graders in the late 1950s when she showed them how close Alaska was to Russia and met Richard M. Nixon when she was in high school. She graduated from Valparaiso University in northwest Indiana, and was the daughter of a high school basketball coach. She is married and has two grown children, both lawyers. She’s a history and movie buff, cultivates a massive flower garden, and bakes banana bread regularly for her colleagues.

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