Governor still mulling whether to agree to state health insurance exchange

Gov. Tate Reeves still has not decided whether he will sign off on creating a state-run exchange to offer health insurance for Mississippians.

“The governor and his staff continue to research the idea to determine if it is in the best interest of this state,” Shelby Wilcher, a spokesperson for Reeves, said in a statement.

Mississippi Insurance Commissioner Mike Chaney has said he believes federal officials, who must approve a state-based exchange, would want a letter from the governor before signing off on the endeavor.

“We probably could operate the exchange, but I don’t think it is wise to do it without having the governor on board or at least having some of his approval to operate the exchange,” Chaney said in June on Mississippi Today’s “The Other Side” podcast. “… It is the governor’s call whether we will have a state-based exchange. We have done all the other hoops we have to jump through.”

A 2013 official opinion for the Mississippi Attorney General’s office indicated that under state law the insurance commissioner would have the authority to operate an exchange if approved by the Legislature. But the AG said it could not opine on federal law or on whether Chaney would have authority under federal law.

Earlier this year the Legislature authorized Chaney to create a Mississippi-based exchange to replace the federal exchange that currently is used by Mississippians to obtain health insurance. The bill to became law without the governor’s signature.

“I am still waiting on a letter from the governor before we do anything,” Chaney said recently. “My prediction is he probably will not do anything before the (presidential) election. That is just my prediction, for what it is worth.”

The exchange was established as part of the Affordable Care Act in 2010. Through the exchange, people can purchase health insurance and people who earn less than 400% of the federal poverty level can receive federal subsidies to help with the cost of the policies.

The federal subsidies are available through both the federal exchange and a federally approved state exchange that adheres to the federal regulations.

Chaney said it’s likely he could entice more companies to offer health insurance on a state exchange and offer policies at less cost than on the federal exchange.

In addition, the companies offering health insurance in Mississippi through the federal exchange currently pay the federal government a fee to operate the exchange. If Mississippi was operating its own exchange, it’s estimated Mississippi could save as much as $37 million a year that currently goes to the federal government to pay the cost of operating the federal exchange here.

Former President Donald Trump, like Reeves, has been critical of the Affordable Care Act. Trump who is seeking a second term after being defeated for reelection in 2020 tried unsuccessfully to repeal the ACA during his first term.

This year he has at times said if he wins election he would not try to repeal the ACA, while at other times said he would try to repeal it when he develops his own health care plan. But Trump admitted recently he does not have a health care plan, though he has been talking about developing one since 2016 when he first ran for the presidency.

While Chaney said he is ready to oversee a state exchange as insurance commissioner, he said Mississippi’s participation in the federal exchange has been a success. Currently more than 280,000 Mississippian have health insurance through the exchange. Five companies offer health insurance policies in Mississippi on the federal exchange.

Chaney said the Republican Governors Association is advocating states create their own exchanges. Georgia, with the backing of Gov. Brian Kemp, recently created its own exchange.

Currently, 21 states plus the District of Columbia have state-based exchanges, though three still operate from the federal platform.

While federal subsidies always have been available for many people who obtain health insurance through the exchange, enhanced subsidies are currently available as part of federal COVID-19 relief legislation championed by President Joe Biden and passed through Congress. A report by KFF, a national nonprofit health advocacy group, estimates that the cost of the exchange policies will increase by an average of $480 per year for Mississippians if the enhanced subsides expire at the end of 2025 as they are scheduled to now.

KFF said it is likely that there will be an effort to continue the enhanced subsidies if Democrat Kamala Harris wins the White House.

It is not clear what action Trump would take on the enhanced subsidies if elected, but during his first term he is credited for action that harmed marketplace participation. The Center for American Progress said the Trump administration reduced outreach effort designed to let people know about the marketplace exchange and reduced the time period to sign up for exchange policies.

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