|MO Health Exchange Referendum - Prop E|
This Discussion Guide is part of Community Conversations at FOCUS St. Louis. It is meant to initiate civil discourse around the policies that affect the St. Louis region; to hear each other’s perspective. As is the case with all public policies, this issue is complex and multi-faceted, with many stakeholders. Please keep this in mind as you discuss the Missouri Health Exchange Referendum in your community.
Missouri Health Exchange Referendum – 2012 Ballot Proposition E
In 2010, the Congress of the United States passed, and the President signed, the Affordable Care Act (ACA), which has also been dubbed "Obamacare.” The law is complex and affects many aspects of health care insurance nationwide.
One important provision of the law is that every state is mandated to establish a health insurance exchange. In the event that a state does not establish its own health care exchange by 2014, the Federal Government is authorized to step in.
The Missouri General Assembly placed a referendum on the November ballot that asks:
"Shall Missouri Law be amended to prohibit the Governor, or any state agency, from establishing or operating state-based health insurance exchanges unless authorized by a vote of the people or by the legislature?”
Note that the referendum does not prohibit the establishment of a state-based health insurance exchange. Rather, it requires that such an exchange must be voted upon by either the General Assembly or by a vote of the people.
Legislation establishing a state-based health insurance exchange failed in both the 2012 and 2011 legislative sessions. In June 2011, the Senate had created the Senate Interim Committee on Health Insurance Exchanges to explore Missouri’s options to establish a state-based exchange.
In the absence of exchange legislation, Missouri’s Health Insurance Exchange Coordinating Council, initially established by the Governor to coordinate the state’s response to federal health reform, moved forward with exchange planning.
The legislation passed by the General Assembly in May 2012 created a ballot measure seeking voters’ input on whether the state can establish a state-based health insurance exchange without approval from the Legislature; such a measure could prevent Governor Jay Nixon (D) from establishing an exchange via Executive Order.
From the Kaiser Family Foundation:
Proponents of Proposition E note that the proposition does not make exchanges illegal, but simply requires a vote of the people or, more likely, legislative action in order to establish such an exchange. The expressed intent is to ensure that the exchanges reflect overall Missouri values, and are not established by the Executive Branch with no outside input.
Who else is involved with this issue?
In many ways, this is a partisan issue, with Republicans largely supporting Proposition E and Democrats opposing it. The proposal was placed on the ballot by the Republican-controlled General Assembly, largely along party-line votes. As well, the original wording of the ballot, written by Democratic Secretary of State Robin Carnahan, was successfully challenged by Republican Lieutenant Governor Peter Kinder. Republican candidate for Governor Dave Spence has encouraged supporters to vote for Prop E.
The State of Missouri has turned down substantial Federal support for establishing exchanges. From, a story in the St. Louis Beacon:
Three Possible Perspectives:
Person A believes that the Affordable Care Act is an encroachment by the Federal Government into health care markets. State-based health care exchanges are an important component of ACA, and passage of Proposition E would postpone implementation of the ACA, hopefully allowing it to be overturned at the national level.
Person B favors the Affordable Care Act, believing that the ACA will help lower overall health care costs in the long run, and help cover uninsured Americans. Anything that delays implementation of ACA should be defeated, including Proposition E
Person C opposed the Affordable Care Act, but is concerned that the Federal government in 2014 is authorized to establish a health exchange in any state that hasn’t already established one. Proposition E would likely result in the Federal government establishing such an exchange in Missouri, and person C would rather have Missourians creating this exchange rather than some federal bureaucrat.
Links for further reading: