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Nixon says Missourians should explore health insurance exchange options

This article first appeared in the St. Louis Beacon, Sept. 27, 2013 - Gov. Jay Nixon says a voter-approved ballot initiative limits what his administration can do to promote the federal health insurance exchange.

But unlike Lt. Gov. Peter Kinder, the Democratic chief executive says the advent of the exchanges is a positive development for individuals looking for health insurance.

Oct. 1 marks the first day Americans can sign up for health insurance through exchanges, an integral part of the Affordable Care Act. Missouri will have a federally run exchange, mainly because of a ballot initiative stipulating that the state can only set up a state-based exchange through legislative action or a statewide vote.

Wording in the initiative – known as Proposition E – also appears to restrict the state from educating Missourians about the exchange. Instead, nonprofit groups – such as the Missouri Foundation for Health – are essentially picking up the slack.

After he spoke to a group of students Friday at Jefferson High School in Jefferson County, Nixon told reporters that the state is “clearly limited in what our direct involvement can be by” Proposition E.

>That proposition states that no governmental entity of shall provide “assistance or resources of any kind to any department, agency, public official, employee or agent of the federal government related to the creation or operation of a federally facilitated health benefit exchange” unless authorized by a state statute or a federal law.

But unlike Kinder – who made headlines this week when he told reporters that Missourians should not sign up for the exchanges – Nixon said the health insurance exchange provides “another option for Missourians to find competitively priced insurance I think is an important opportunity.”

“And they should explore those options,” Nixon said. “I think it is especially important that they do it.”

Nixon went onto say that he’s been “heartened” by interim committees looking at ways to change the state’s Medicaid system, “hopefully we can not only provide a cost competitive opportunity for them through the exchanges, but also, very importantly, draw down those federal dollars and strengthen and increase the opportunity for health care improvements through Medicaid.”

Nixon has advocated strongly in favor of expanding the state's Medicaid program, as recommended by the Affordable Care Act, also known as Obamacare. So far, the General Assembly has declined to do, although the federal government would pick up all the added costs for the first three years, and at least 90 percent thereafter.

Missourians who would qualify for the Medicaid expansion are generally excluded from getting any tax subsidies if they participate in the health insurance exchange.

While the Missouri General Assembly placed Proposition E onto the ballot, it passed statewide by roughly 60 percent of the vote in November 2012. When asked if more should have been done to combat the initiative during last year’s election cycle, Nixon said “I think that the time when it occurred, it was kind of in a political zone.”

Nixon was running for re-election.

“I think that it was taken down in a crucible of 'Are you for it or are you against it ?' based on kind of the presidential race,” Nixon said. “And I think that each day we get past last November is another day toward hopefully, thoughtful thoughts about how we can move forward. I don’t know what difference could have been made in the heat of that time on that particular vote.”

Missouri 'well prepared' in event of shutdown

Nixon also said that he doesn’t expect a potential government shutdown to impact state government that much, adding “we've run all the scenarios and we’ll be well prepared if anything happens there.”

Such a shutdown could happen as of midnight Monday, if Congress fails to approve a budget measure -- known as a "continuing resolution" that would keep the federal government operating.

But Nixon – who recently was in New York for several days – said that Missouri manages to pass a budget every year. And, he added, Congress should look to the state as a guide.

“My golly. We have our differences here in Missouri. We have differences of parties, differences of regions,” Nixon said. “But we agree that we’re going to get our budgets done and done on time each year. And I think Missouri can serve as a model for the country. While you can have disagreements and you can get high-toned, you need to meet deadlines and you meet those deadlines.”

“I just think that shared value of ‘we’ve got to get it done’ is really important on the fiscal side,” Nixon said.

“One of the things in D.C. that I find odd is Missourians and Americans understand budget challenges a lot more than the politicians think they do and are much more realistic and supportive of necessary trimmings,” he added. “I’m hopeful that they can get a deal and quit having what would appear to be a political circus every three to six months.”

Three major Missouri business groups joined a coalition of several hundred business organizations nationally who issued a statement Friday calling on Congress to pass the budget measure, as well as separate legislation raising the nation's debt limit. The current limit is expected to be breached in a couple weeks.

The three Missouri groups are: the Missouri Chamber of Commerce, the Missouri Association of Manufacturers, and the Springfield, Mo. Chamber of Commerce.

Won’t leave license collector post vacant

Nixon also said that he is going through the process of picking a new license collector for St. Louis. That post became vacant this summer after Michael McMillan became head of the city’s Urban League.

He confirmed that he would not simply leave the position vacant, as some Democrats had speculated .  The governor said he was “looking for a good, solid candidate there who can continue the technological improvements that Mike McMillan made.”

“That’s certainly something that’s sequenced to the front of line,” said Nixon. He explained the delay in his decision by noting that, among other things, his occupation with the recently completed legislative veto session, and his recent trip to New York

Several Democrats have noted an interest in being appointed to the license collector post, including state Rep. Karla May, D-St. Louis, Alderman Jeffrey Boyd, D-22nd Ward, and Alderwoman Donna Baringer, D-16th Ward. Whoever is appointed to the post will have to run citywide for a full term next August.

Jason is the politics correspondent for St. Louis Public Radio.

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