This article first appeared in the St. Louis Beacon, March 13, 2012 - Missouri will take no immediate steps to establish an insurance exchange in spite of the federal offer to give states more flexibility in setting up this key part of the health-reform law, a key state senator said Monday.
Sen. Scott Rupp, R-Wentzville, made the comment in response to the federal government's announcement on insurance exchange rules. Rupp chaired the special committee that held hearings across the state last year to get public reaction to setting up an exchange in Missouri. He also chairs the Small Business, Industry and Insurance Committee, which has jurisdiction over any exchange legislation introduced in the Senate.
"I am very confident that the Legislature is not going to act on anything related to an insurance exchange," in the current legislative session, Rupp said Monday.
On Monday, the Department of Health and Human Services clarified how the exchanges would work and modified its deadline for states to set up their exchanges. Initially, states were supposed to have them in place by 2014. The government now says states that are behind schedule will be allowed to set up their exchanges after 2014.
HHS Secretary Kathleen Sebelius said in a statement Monday that the agency's policies would "give states the flexibility they need to design an exchange that works for them."
But Rupp remains unimpressed.
"The federal government has always pushed back all these supposedly hard deadlines," he says. "So that threat of you have to have it done by this date has pretty much fallen on deaf ears."
He says Missouri and many other states were "in a holding pattern" until the Supreme Court hands down a ruling, expected by June, on the Affordable Care Act. Once the law is clarified, Rupp says Missouri will then decide what to do about an exchange.
Federal officials continue to point to a business model similar to Expedia or Orbitz as the way an exchange would operate. It envisions consumers using the system to shop for health insurance in the same way they might compare prices and buy an airline ticket or book a hotel room.
Sebelius says the "one-stop shopping for health insurance" model will force insurers to compete for business. "More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today," she said.
Although Rupp and many other Republicans have insisted that the legislature take no action on an exchange during this session, some Democrats, such as state Sen. Joe Keaveny, D-St. Louis, have argued that Missouri might end up missing an opportunity to decide how its exchange should be structured.
The federal government has said it would impose exchanges on states that fail to build their own. Yet it's unclear whether that rule still stands now that the federal government appears ready to show more flexibility.
The big issue for most states isn't necessarily the enabling legislation to set up an exchange but the lead time needed to build the internet infrastructure to run an exchange. In some instances, federal officials have said, states lagging behind might be able to use parts of an exchange system built by another state.
