Contrary to what was reported in this newspaper on Sunday, I did not “help design the [state health insurance] exchange used today,” and I have consistently opposed the creation of an exchange under the Affordable Care Act (ACA). A brief call to my office before publishing these inaccuracies – and others – would have been helpful.
The confusion likely comes from our organization’s support several years ago of a vastly different type of exchange. Unlike the one being designed by the Mississippi Insurance Department, the exchange we proposed would not have been subject to federal control and employers would not have been subject to crippling financial penalties if they chose not to participate.Ideally, there would be no reason for the government to be involved at all in the purchase of private health insurance. If the exchange were nothing more than an online marketplace, for instance, it would not be necessary. Websites like ehealthinsurance.com already serve this purpose. But under federal tax laws, employees must use after-tax income to pay for insurance coverage they purchase through these sites.
The exchange we proposed provided a workaround these onerous tax laws, allowing small businesses to provide a broader array of health insurance options to their employees – who would have been able to choose a plan to meet their needs, rather than being stuck with the plan chosen by their employer. In turn, employers would have been relieved of much of the administrative burden – and hopefully some of the cost – of providing insurance to their employees.
Our state Insurance Department claims that the exchange they have set up would do exactly that. Apparently the Clarion-Ledger agrees with this claim. But your editorial comment that the current Mississippi exchange “is not connected to President Obama or the ACA” is absurd. They are joined at the hip.
The reality is that the ACA gives the federal government nearly complete power over the state exchange. Whether or not the feds are exercising that power at this moment is irrelevant. It is naive to think they won’t exercise it at some point in the near future.
The exchange authorized by the ACA is the mechanism through which the federal government will implement new mandates, new penalties on employers, and massive subsidies that will expand the welfare state to the middle class. The exchange will also facilitate a costly increase in Medicaid enrollment.
As noted by the Heritage Foundation, another pre-ACA supporter of health insurance exchanges: “The combined effect of [new federal] regulations and grant requirements are that a state would have to agree to surrender any last vestiges of meaningful control over how ObamaCare is implemented. Thus, a state would now have no more real control over an exchange it set up than over one HHS established. “Consequently, at this point the best course of action for states is to neither apply for nor accept exchange-establishment grant funding.”
Since Mississippi has already accepted such funding, the next-best thing is for us to discontinue our pursuit of the exchange. Thus far, the feds have not indicated that states that have already spent these grant funds will have to pay them back should they decide to stop pursuing an exchange.
It is true that the ACA allows the federal government to set up an exchange in states that don’t establish their own. But Congress has not appropriated money for that purpose, and presumably, as long as Republicans are in control of at least one house of Congress, they won’t. If there is no money, there is no exchange; if there is no exchange, there are no job-killing employer penalties.
Opposing the establishment of a state-based health insurance exchange is one of the few things Mississippi can do to take a stand against further intrusion of the federal government into the decisions that should be made by individuals or the states. Repealing ACA is the starting point for redirecting the nation’s attention to reforms that will address the real problems in our health care system. In the meantime, let’s stop our state’s complicity in implementing it.