Republican legislators in Missouri—and in fourteen other states—want to have their cake and eat it too when it comes to the Affordable Care Act, aka ObamaCare, by refusing to set up state health insurance exchanges for their residents, but then regulating the federal exchanges to make them harder for consumers to use.

More than 850,000 Missouri residents are uninsured. Many could qualify for coverage through the exchange, if they are able to understand the system and claim their rights.

First Missouri passed a law forbidding state and local government officials from cooperating with the federal exchange and giving citizens the right to file lawsuits against them if they do, and last week Democratic Governor Jay Nixon signed a bill that includes a provision regulating the exchange, which is intended to be a one-stop shopping site for people who lack affordable, job-based health insurance.

Drafted by the National Conference of Insurance Legislators, which opposes federal involvement in the insurance industry, and backed by insurance agents and brokers, the law requires insurance counselors—known as navigators—to get state licenses, take ongoing training, pay a fee and post a bond before they begin helping consumers shop for health plans on the exchange.

Although the navigators are supposed to help consumers sort through the often confusing maze of options and figure out what is best for them, the bill states that they cannot “provide advice concerning the benefits, terms and features of a particular health plan, or offer advice about which exchange health plan is better or worse for a particular individual or employer.” 

Critics point out that there is no need for state training, since navigators already must take a 30-hour federally required training course and pass an exam. In addition, there is simply no time to design and implement a regulatory system that can be ready by October 1, when open enrollment begins. Finally, there is a good chance that state regulation of the federal exchanges is a violation of the Constitution’s Supremacy Clause, which makes federal law controlling when a conflict arises with state law.

“It’s very clear that states cannot enact state laws that impede the Affordable Care Act,” said Lisa D’Souza, a health law and policy fellow at St. Louis University. “This bill certainly has a great potential to do that.”

“I don’t understand the opposition,” claimed Larry Case, executive vice president of the industry-backed Missouri Association of Insurance Agents. “To me, it’s just common-sense consumer protection.”

But Tim Jost, a health law expert and professor at the Washington and Lee University Law School, contends this is about money. “Agents and brokers are pushing this very hard because they’re concerned about losing market share. It’s interesting that states that don’t care about implementing the Affordable Care Act in any way, shape or form decided this was the one issue that just urgently needed their attention.”

-Matt Bewig

To Learn More:

New Missouri Law Imposes Hurdle for Insurance Exchange (by Virginia Young, St. Louis Post-Dispatch)

Missouri Citizens Face Obstacles to Coverage (by Robert Pear, New York Times)

Enroll Missouri (Missouri Hospital Association)