It is a clearinghouse. If a company wants to sell any type of insurance in Mississippi, the company needs the state’s permission and stamp of approval.
Although at times the Insurance Department has protected insurance sellers more than insurance buyers, it is first and foremost a consumer protection agency.
The conflict between Chaney and Bryant arises from a mandate in the federal Affordable Care Act (which even the president now calls Obamacare). The provision tasks states to create health insurance exchanges.
An exchange is complicated in operation, but not in concept. It is nothing more than a list of all health insurance plans private companies desire to sell. The companies offer details of what’s covered at what price. The government’s role is merely to centralize, to keep consumers from being ripped off.
Indeed, way back in 1991, the Mississippi Legislature itself established a health insurance exchange. The problem back then was that there were a lot of Mississippians deemed too risky by health insurance companies. As individuals, they couldn’t buy policies at any price, or at least at anything approaching a reasonable price.
Lawmakers created the Comprehensive Health Insurance Risk Pool Association to serve much the same purpose as the Obamacare exchanges. The idea was that policies could be more affordable if companies could spread their exposure to big claims across a larger group of high-risk clients.
Bryant, a Republican, is philosophically and adamantly opposed to the nationalization of how Americans pay for health care, which is the broader effect of Obamacare. And so is Mike Chaney, also a Republican and former state representative and senator now serving his second term as director of the Mississippi Insurance Department.
But Chaney chose to ignore Bryant’s wishes that the state refuse to establish an exchange.
Chaney responded that (1) Obamacare is the law of the land and (2) Mississippi could go through the tedious and detailed steps to create an exchange or (3) federal authorities would create and operate an exchange in the state.
Chaney landed grants, about $21 million worth, and the process took about a year. It’s pretty transparent. About 2,000 pages of information about the state, its people and their health-care needs were compiled and provided on a website for any person to see and for companies to use in calculating the risks and rewards of selling health insurance in Mississippi.
The next step was to submit the exchange, dubbed One Mississippi, to the federal Department of Health and Human Services for review. And that’s where things stand.
The federal regulators said they are leery about giving their blessing to a state plan being openly opposed by the state’s governor. An opinion was obtained from Attorney General Jim Hood (Democrat) last week affirming that Chaney had full authority to design and operate the exchange, whether Bryant likes it or not. But HHS is still reluctant.
Who are the uninsured in Mississippi? We don’t know. We know those 65 and older have Medicare. We know about 500,000 or poor or disabled and have Medicaid. But there are thousands and thousands more who by choice or inability to pay have no coverage.
We know some things about Mississippi’s uninsured. A large group, 76,500, is composed of families where the husband and wife are both employed, but neither has insurance. Another large group, 67,700, is composed of families where one spouse has a job and neither has insurance. There are about 7,000 people with household incomes above $150,000 per year who don’t have health insurance.
We know that 72 percent of the people without health insurance are single and the rest are married.
But there is no data about almost one-fourth of all the state’s uninsured.
As envisioned, state health insurance exchanges will be portals where individuals and where employers with fewer than 100 employees will be able to (or required to) shop, perhaps more competitively, for private health policies.
Whether people should be forced to buy health insurance and fined if they do not continues to be a topic of legitimate debate.
Whether it’s in Mississippi’s interest to create and operate an exchange is not. Chaney is serving the public’s interest. Bryant is standing in the way of the Department of Insurance fulfilling its century-old mission.
Charlie Mitchell is a Mississippi journalist. Write to him at Box 1, University, MS 38677, or email firstname.lastname@example.org.