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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. (more…)

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