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S.C.’s Questionable Bid For A Private Insurance Exchange

From American Medical News:

Gov. Nikki Haley’s email influence flap sheds light on the struggle of states that don’t want to implement reform themselves but don’t want federal intervention.

By Doug Trapp

Jan. 9, 2012

A South Carolina state commission concluded in late 2011 that neither a state nor a federal health insurance exchange is feasible, mirroring the position pushed by South Carolina Gov. Nikki Haley before she created the commission. The panel instead called for a private insurance marketplace to be run by health plans and modeled on travel search engines.

State leaders around the nation are vigorously debating whether to implement state health insurance exchanges as outlined in the national health system reform law, or to allow a federal health exchange. Both would provide a marketplace for new individual and small group health insurance and coordinate Medicaid enrollment. The health reform law requires either a state or federal exchange to be implemented, although states later can take over a federal exchange.

But some state leaders are concerned that cooperating with the federal government could come with high costs. So far, 13 states have enacted legislation to create exchanges, according to the National Conference of State Legislatures.

Some states have sent mixed signals on the national reform law. A majority of states have accepted at least one federal grant to help pay for exploring the feasibility of a health insurance exchange, but several of these states at the same time are suing the federal government to block implementation of the law.

South Carolina is one of these states. In late 2010, the state’s Dept. of Insurance accepted a $1 million federal exchange planning grant — requested by then-Gov. Mark Sanford’s administration in August 2010 — while the state pursued a joint lawsuit to block the health reform law.

13 states have enacted laws to implement health insurance exchanges.

Haley, a first-term Republican governor, pushed to avoid implementing either a state or a federal health exchange. This would limit the appearance that her administration was allowing the Democratic-supported health reform law to move forward in her state, according to emails provided in December 2011 by the South Carolina Dept. of Health and Human Services to The Post and Courier of Charleston.

Haley issued an executive order on March 10, 2011, creating a committee to study the feasibility of health insurance exchanges. “The whole point of this commission should be to figure out how to opt out and how to avoid a federal takeover, NOT create a state exchange,” she wrote in a March 31, 2011, email to her staff and Anthony Keck, director of the South Carolina health department.

Haley appointed five of the 12 members of the exchange planning committee and designated three others to serve — including Keck — because of their positions in her administration. The remaining four members were appointed by the leaders of the South Carolina House and Senate. Continue reading

Haley’s Panel: No State Health Insurance ‘Exchange’ For S.C.

From The Post & Courier:

By Renee Dudley


Friday, November 18, 2011

South Carolina should not manage its own “exchange” where health coverage will be sold once the new federal health care law takes full effect in 2014, a state panel is expected to recommend today.

The S.C. Health Planning Committee wants private companies to create their own exchanges to sell insurance, an option critics said will face resistance and likely lead to a federal takeover of the process.

If Gov. Nikki Haley approves the recommendations, South Carolina would join a handful of other states in declining to set up its own exchange — the website and hotline where health coverage will be sold to residents who qualify for subsidized insurance as part of federal health care reform.

Instead of a single state-managed website, members of the Health Planning Committee, who include state Health and Human Services Director Tony Keck, said private entities should set up their own sites to sell insurance.

Keck said small businesses or insurers could band together to build their own exchanges. The resulting sites would be similar to having a choice of Travelocity, Orbitz and Kayak for buying discounted airline tickets, he said.

Advocates for the uninsured, however, said buying health insurance is a complicated transaction. Allowing private companies to manage exchanges could open the door for insurers to take advantage of the poor, they said. Continue reading

Haley’s Waiting Game On S.C.’s Health Insurance Exchange

From Kaiser Health News:

S.C.’s top health official, Anthony Keck, and Gov. Nikki Haley, not fans of the 2010 health law, are likely to decide to let the federal government run the state’s exchange. (Haley photo by MaryAustinPhoto via Flickr)

By Christopher Weaver

Nov 15, 2011

South Carolina’s top health official will recommend this week that the state decline creating its own health insurance exchange, one of the central tenets of President Barack Obama’s health care law.

Instead, the state should let the federal government build the insurance marketplace in the state for now, Anthony Keck, the director of the state’s Department of Health and Human Services, said in an interview. That recommendation is expected to go to a committee appointed by the governor to study the issue on Friday.

South Carolina, a state dominated by health-law-averse Republicans who got a Tea Party boost in last year’s election, has been heading down this road for months. But the recommendation is the latest step in formalizing objections to the exchange — and it frames the move as pragmatism, even as the state hands over power to the federal government.

The No. 1 reason for the wait-and-see approach? The stakes are so low. If a state does nothing, Washington is required to step in and build an exchange by 2014. That thinking — as well as a list of technical and logistical problems — is swaying decision-makers in other states too, industry analysts say.

State officials say the 2014 deadline is too tight given that rules for the exchanges are not complete, which is one incentive to defer to Washington. Plus, if South Carolina officials don’t like the federally run exchange, they can always circle back and start their own later under rules issued by the federal health department in July.

“What is the first mover advantage for states to rush ahead and implement this, given all the uncertainty?” Keck asked. “States have the safety valve of being able to take it over when they want to.”

“Sometimes, the smartest thing when you’re doing something new like this is to wait,” he said. Continue reading


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