Backers compare health insurance exchanges to Travelocity or Expedia. Websites where you can quickly compare prices and features to get the best deal. But detractors oppose them as a federal intrusion into the health care market. In this weekly Health & Wealth update, Missourians debate the merits of Obama's health reform law, as state lawmakers try to decide whether to authorize an exchange.
Between legislative sessions, a senate committee is traveling the state taking public testimony on whether to establish a state-run exchange, or let the federal government create one.
Last session, the Missouri house passed a Republican-sponsored bill to create the "Show-Me Health Insurance Exchange," but the bill stalled in the senate, over opposition from "Obamacare" critics.
State Senator Jane Cunningham was of those critics. "I have looked at the bill from last year, and it gives total control to the federal government," she told me. "I went through it with a fine-tooth comb. There were 46 instances where it referred to the federal government, and health and human services approving everything we've done."
Would she consider a bill next session, if it kept more control with the state? "If it's possible. I don't know what's possible at this point, but I'm certainly open," she said.
At the most recent public hearing, outside St. Louis, the committee listened to over three hours of testimony -- some of it eliciting boos and cheers from the packed auditorium.
Very few people addressed the question at hand, but rather, spoke for or against the Affordable Care Act, touching all the hot-button issues: abortion, death-panels, pre-existing conditions, the intent of our founders, etc.
Sidney Watson, a law professor at St. Louis University's center for health law studies, urged the committee to adopt a state exchange.
"It gives Missouri lots of choices on how to set up an exchange that meets our needs best. Things like whether we want to merge the small group market with the individual market, and have one big pool. One benefit of that is typically larger pools are simply less costly."
She said, in addition to an expanded pool, the exchanges will bring down overhead costs.
"Instead of insurance companies having to talk to each one of us individually, they can market on this one site. So, right there, we expect to drop maybe 15 percent off of the overhead costs."