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Q&A: Mike Chaney, Mississippi Commissioner of Insurance

Exchange not likely

Mississippi moving forward despite state, national challenges

States that don’t develop their own White House-mandated health insurance exchanges by January 2013 will be subject to a federally operated exchange. Most states nationwide are having trouble developing these plans. Despite the Mississippi’s Legislature’s killing of proposed exchange legislation this session, the Mississippi Insurance Department is moving forward with a plan to put the exchange under the state’s high-risk pool.

Q — Define health insurance exchange in layman’s terms.
A —
If you’re going to travel from Jackson, Miss., to Chicago, Ill., you can go to Expedia, Travelocity or Priceline, and you can by a ticket to be first-class from Jackson to Memphis to Chicago. Business-class, front-row seat for $1,000. You’ve got economy-class to Atlanta on Delta with a lot of delays for $250 — that’s just an example. You pick where you want to go, what you want to pay and what you need.

Q — Tell us about your healthcare exchange legislation that was killed this session.
A —
We proposed legislation after meetings with many stakeholders as to how they thought an exchange should be structured and how it would best be serviced — either through the state or through a nonprofit as the federal law mandated. We determined that nonprofit was the best way to set a health benefits exchange up. Unfortunately, politics, for whatever reason, killed the bill that we had before the legislative conference committees. People can say it was over who was going to be on the board — how it would be constituted. They can say it was because it was to be a a state agency or a nonprofit operating system. But the real reason was politics. That simple.

Q — Now you want to put the exchange under the state’s high-risk pool?
A —
Based on the fact that the bill was killed, we did a lot of research on the codes that exist on our books today in Mississippi. And under section 83-9-213(2)(p) the Mississippi Insurance Department has the authority to tell the Mississippi high-risk pool — the Mississippi Comprehensive Health Insurance Risk Pool Association — we have the ability to ask them to do whatever is necessary to provide health and accident insurance coverage to the citizens of Mississippi under any state or federal program designed to enable people to obtain or maintain health insurance coverage.

Section 83-9-213(3) states: “The commissioner may, by rule, establish additional powers and duties of the board and may adopt such rules as are necessary and proper to implement Sections 83-9-201 through 83-9-222.”

We have sent a letter to that effect to the governor, and we have made a proposal to (high-risk pool) that we believe the high-risk pool is the best place to operate an exchange — it’s a nonprofit — and they have taken that under advisement as to whether or not they would operate an exchange. We believe they will. We’ve informed the governor.

We would prefer to have a market-driven, consumer-oriented exchange that would be utilized by all Mississippians. it was my aim in conjunction with the high-risk pool to create an exchange for the small employers of Mississippi that functions similar to the defined contributions systems implemented operated by the Utah Health Exchange. Somewhere in between the Utah exchange and the Massachusetts health exchange is where we want to be.

We met with Gov. Barbour, and he seemed very pleased with what we were doing. We’ve got a lot of time to do some things. And we don’t have to have legislative mandates to do this. We may have to have the governor sign off on it. That doesn’t seem to be a problem right now.

Q — How many other states are in our same boat as far as trying to get their health exchanges together?
A —
There are 14 states in the Southeastern zone, and only one state has passed any legislation, and that’s West Virginia. It appears that Georgia’s legislation was vetoed by the governor. Oklahoma’s (not in the Southeastern zone) was vetoed by the governor, and Louisiana — Gov. Jindal — is not sure what he wants in the way of an exchange. Arkansas has killed all of their efforts of the legislature. Tennessee has killed theirs. Alabama’s killed theirs. Florida said no. South Carolina’s governor said no. North Carolina has not been successful. Virginia has not been successful. My perspective on healthcare is that very few states will be successful in setting up and implementing an exchange as Congress anticipated. I don’t know what will happen with the Congress that we have now and the administration that we have.

Q — Why a nonprofit?
A —
One of the reasons we prefer a nonprofit is that it gives us the ability to be very nimble and quick and jump over the federal candlestick.

Q — Do you think an exchange will help make the market more free and flexible?
A —
It’ll make the market flexible if it catches on. The real kicker is the exchange programs may not catch on. They may not work.

Q — Will the exchange be able to offer Health Savings Accounts?
A —
We’d like to. There are some new rules that deal with HSAs under the Affordable Care Act. They’re cutting back on what you can contribute to one a year.

More on Chaney:
Favorite Food:
Hamburger
Most recently read book: “The Big Short” by Michael Lewis
Most recently watched movies: “The King’s Speech” and “The Lion King 2” with grandkids

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