what eye thynk: With apologies to Charles Dickens...this is The Tale of Two States.
Colorado - "It (is) the best of times..."
Colorado has received $180 Million in federal dollars to cover the cost of setting up and running their ACA insurance exchange for the first year. And the exchange, Connect for Health Colorado, is just about ready to go. Television commercials are touting the new market and encouraging people to be ready to sign up on October 1. Employees of the exchange, outfitted in t-shirts that read "Got Insurance?" are blanketing Colorado explaining how the system will work. Four hundred guides are being trained to help the uninsured sign up for coverage.
In 2011, believing that it would be best for Colorado to have control over the way the ACA market was run in their state, Republicans, who controlled the state's House of Representatives at the time, joined with Democrats to pass legislation allowing for the creation of a state-based insurance market. This year, they approved the expansion of Medicaid, both parties again agreeing that assistance was better than hindrance.
Not everyone in Colorado is a supporter of the Affordable Care Act, but there are enough reasonable Republicans in that state that when a bill was introduced in February that would have stopped the insurance exchange from going forward, the majority of Republicans voted with Democrats to defeat it.
Patty Fontneau, executive director of Colorado's insurance market said "Will it be perfect? Unlikely, but we have the right team in place to ensure that we're going to be open and running, and as close to perfect as could be, on October 1." Gov. John Hickenlooper (D) added "We'll do whatever it takes. I'll ride around the state on a bicycle if I have to."
Missouri - "It (is) the worst of times..."
Missouri has refused to create an ACA insurance exchange, opting instead to turn down available federal money and to let the federal government run the insurance market in their state. But state officials have taken their refusal to cooperate a step further. Missouri law now forbids state and local officials from providing "assistance or resources of any kind". This includes co-operating with anyone working for the federal exchange. Any local or state official who flouts the restrictions can be sued by the state legislature or even by a taxpayer.
State Senator Rob Schaaf (R) who authored the law preventing the creation of a state-run exchange: "We can't afford everything we do now, let alone provide free medical care to able-bodied adults. I have a philosophical problem with doing that." It should be noted that Mr. Schaaf. who is himself able-bodied, is covered by health insurance paid for by Missouri's state employee insurance program.
The result of Missouri's no-assistance law is a market place with no marketing, no local office, no official voice, no board of local advisers, and no way to obtain detailed information about the available insurance plans or their prices. Missouri has set up additional roadblocks for the companies that want to offer insurance through the ACA by requiring them to obtain state licenses before they can begin to help consumers navigate the new insurance market. And, like many Republican run states, it has refused to expand Medicaid for its neediest citizens.
Missouri's stand on forbidding local officials from providing information on the insurance market is hurting not only insurance customers, but also insurance sellers. Kenneth Schmidt, an insurance broker who is hoping to sell health insurance in Missouri: "We have not seen any evidence of the federal exchange--how it will be run, how it will be structured in Missouri...Who will watch over it? No clue."
Business owners are also being left in the dark. David Griggs, store owner: "I have not seen or heard a word about it." Kat Cunningham, President of Moresource, a company that provides payroll services for Missouri businesses said she has been deluged by clients asking "Where do we go to purchase health care coverage? How much will it cost us?" When she went to local officials for information, she came away with nothing.
Josephine Waltman, health officer for Phelps County says that she and her staff want to help, and are equipped to sit down with the uninsured and assist them in understanding the world of available subsidies and insurance plans; but state law forbids them from doing so. Instead they answer questions with vague references to the federal exchange, leaving those who need insurance the most with little information required to navigate the confusing new programs by themselves.
Private organizations are trying to step up to fill the gap--Missouri Foundation for Health is spending $8 Million in their attempt to get information out, but their efforts also run into roadblocks. State and local officials who have knowledge of the federal exchange are hesitant to share it for fear that the legislature will sue them.
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I can't help but wonder what people like those in Missouri will think when they look across state boundaries and see people in other states enjoying rights that should also be available to them...no matter who is in charge.
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