Mississippi gets a jump on creating exchanges

“Thank God for Mississippi.”

That phrase, when uttered by public health experts elsewhere in the South, is seldom a compliment. When contemplating the poor health statistics in their own states, they’ve been known to take some comfort that the Magnolia State fared worse.

But when it comes to the issue of building a health insurance exchange, those comparisons are turned on their head.

While other Southern, Republican-dominated states such as Georgia have put the idea of a health insurance exchange on hold –- or have dismissed it entirely, due to its connection to the Affordable Care Act (ACA) — Mississippi has forged ahead in creating its own such online marketplace in 2014.

“It’s about time for Mississippi to be out in front,’’ Therese Hanna of the Center for Mississippi Health Policy said Thursday in an interview with Georgia Health News.

Health insurance exchanges are meant to function in a way equivalent to online travel agencies. Individuals and small businesses would shop for health care coverage, with insurers competing with each other based on price and quality.

Exchanges are a major part of the ACA, also known as the health care law, which was recently upheld by the U.S. Supreme Court. Unless the ACA is repealed through Republican victories in the November elections, exchanges will be part of every state beginning in 2014. If a state fails to create its own, the federal government will run one there.

Health industry officials in Georgia have expressed a preference for the state to run its own exchange.

Graham Thompson of the Georgia Association of Health Plans told GHN in June that his membership ‘‘would much rather have a Georgia-centric solution.”

Insurance exchanges have been running in both Massachusetts and Utah for years.

In the aftermath of the Supreme Court ruling, Gov. Nathan Deal said Georgia would wait until after the November election to decide whether to create its own health insurance exchange.

The Obama administration has set a Nov. 16 deadline for state governments to submit proposals showing how they intend to operate health insurance exchanges in 2014.

Deal said in June that he supports the concept of small businesses being able to band together to buy health insurance, which was a recommendation of the study commission on exchanges that he created.

Deal’s office appeared to take a more negative line Thursday, after a query from GHN. Deal spokesman Brian Robinson said, “A health insurance exchange as proposed in the Obamacare law [the ACA] does not appear to be beneficial to Georgia’s taxpayers. Until the implications of Obamacare are fully understood, we do not intend to implement health insurance exchanges here.’’

When asked whether Georgia may join other states in creating a regional insurance exchange, Robinson replied, “We aren’t taking any steps until after the November election.”

Tea Party opposition could make it difficult for Georgia to create exchanges. The loosely knit movement, which calls for limited government, previously helped block exchange-enabling legislation in the Legislature.

And the Tea Party reaffirmed its clout this week. It spearheaded the decisive defeat of a transportation tax referendum, even though the measure’s supporters spent heavily and had the backing of key officials, including the governor.

Like Georgia, Mississippi was one of the 26 states that filed a legal challenge to the Affordable Care Act, in the case that eventually reached the Supreme Court.

Mississippi’s rate of uninsured residents, 21 percent, is similar to Georgia’s.

The state has been working on a health insurance exchange for a few years prior to the 2010 passage of the ACA.

According to the Center for Mississippi Health Policy, about 275,000 Mississippians are expected to enroll in coverage through an exchange once the ACA is fully implemented in 2014. Out of those, an estimated 229,000 should be eligible for premium subsidies.

The state’s insurance commissioner used a statute already on the books to launch the exchange effort, said Hanna, executive director of the Center for Mississippi Health Policy.

Small businesses in the state have been pushing the exchange idea for years, predating the ACA, she said.

Tea Party activists in Mississippi recently voiced opposition to the exchange effort, Hanna said.

Mississippi Insurance Commissioner Mike Chaney, a Republican, said in a July statement that no final decision on the exchange would be made till after the November elections.

But Chaney added, “We will, however, continue to do those things toward the establishment of an exchange that we must do to keep us in a position to make the best decision in November for all Mississippians. That is the only way to keep all of our available options open.

“If we halt everything now, we will have prematurely surrendered Mississippi’s health insurance market to federal control. I took an oath of office to protect the interests of the people of Mississippi and that is what I intend to do. “

Chaney said in a Kaiser Health News article earlier this year, “It appears that I am swimming upstream against the trend of other Southern states but here is the problem: other Southern states did not have in place the statutory law that I had in place.”

The blueprint taking shape in Mississippi appears to be creating a separate exchange for individuals and for small businesses, which would share the same governing structure, Hanna said.

The Center for Mississippi Health Policy released a study finding that a working exchange, along with an expansion of Medicaid, could help lower the rate of people in the state without insurance from 21 percent to 7 percent.

Meanwhile, former U.S. Senate Majority Leader Bill Frist, a Republican from Tennessee, recently urged state leaders in both parties to move quickly to establish state-based insurance exchanges.

Frist, who is also a prominent surgeon, noted that exchanges were originally a Republican idea.

“State exchanges are the solution,’’ he said in an editorial. “They represent the federalist ideal of states as laboratories for democracy. We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics.’’