While Insurance Commissioner Mike Chaney previously said he would not create a state exchange to offer health insurance to Mississippians unless Gov. Tate Reeves approved, the elected official who oversees the state’s insurance licensing and regulations is now pondering how to move forward in the case of Reeves not signing off on the state operating its own exchange in place of the federal government.
During a Monday interview on MidDays with Gerard Gibert, Chaney explained that Mississippi could save between $25 million and $30 million annually in fees if the state established an in-house exchange for Affordable Care Act (ACA) plans. In addition to saving money, the commissioner vouched that moving away from the federal government’s health insurance marketplace – which 19 states and Washington, D.C., have already done – could result in lower premiums along with secondary benefits being offered for those enrolled.
“We would make that much money that would stay put in the state, and then, you can use that money to either lower premiums for people in the state or you could use that money to offer other ancillary products like dental, hearing, and eye,” Chaney said. “There’s a lot of options for us to use that money.
“What you don’t want to use that money for is buying new pickup trucks for folks and stuff and other things the government normally does,” he laughed. “It’s strictly for healthcare.”
But, according to Chaney, Mississippi will not see any of the money unless the state exchange is settled in not only the governor’s office but also with the Centers for Medicare and Medicaid Services (CMS). During this year’s legislative session, a Republican-led majority of lawmakers passed a bill giving the insurance commissioner the authority to set up the state exchange. However, the bill became law without Reeves’ signature or any rationale behind his decision not to sign.
Chaney, who said he hasn’t spoken directly to Reeves about the matter since January but has discussed the possibility of a state exchange with Reeves staffers as recently as April, believes the Republican governor may come around to the idea after the upcoming election. CMS has informed Chaney, also a Republican, that it requires a letter from Reeves to fully open the door for Mississippi to move away from the federal Affordable Care Marketplace Exchange.
“We got a very, very good bill that would allow us to establish a state-based exchange,” Chaney said, adding that costs for the creation would not come from Mississippi’s general fund. “But CMS has told me and the legislature they would require a letter from the governor to establish a state-based exchange.
“We asked [Reeves] to do one back in April. I haven’t pushed him because we have until the end of 2025 to get everything up and running – which we can do. That decision will probably be made after the November elections and we know who the new president will be and kind of have an idea of where we’re at on those health policies that they will probably sign into law or oppose come January or February.”
During a September presidential debate between Republican Donald Trump and Democrat Kamala Harris, the vice president said she would move to strengthen the ACA. Trump, who during his first presidency attempted to repeal the ACA but to no avail in Congress, vouched that enrollees need “much better,” and he has a plan to either improve or replace the ACA.
Putting who might be the next president aside, say nothing changes with the current ACA model, Chaney said he may file litigation against CMS if the federal agency does not allow Mississippi to create a state exchange without a letter from the governor.
“At that point, I have the option of the commissioner to go into CMS and tell them they cannot tell us we cannot have a state-based exchange. Legally, they cannot,” Chaney asserted. “If that happens, then we’ll go down the road and I’ll probably end up suing CMS for somewhere around a billion dollars.”
As Reeves remains mum on whether he will back the creation of a state exchange – even though the Republican Governors Association is now vouching for states to create their own exchanges, per Chaney – he has historically been an avid critic of anything related to the ACA. The ACA Marketplace Exchange allows people who earn less than 400% of the federal poverty level to receive subsidies to help with the cost of health insurance policies with around 12% of Mississippi’s population currently utilizing the program.
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