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EXPERT AVAILABLE: Missouri Health Insurance Exchange Law Could Cause Problems, MU Expert Says

The lack of partnership with a federal insurance exchange could cost Missouri tax payers

January 23rd, 2013

Story Contact: Nathan Hurst, 573-882-6217,

The views and opinions expressed in this “for expert comment” release are based on research and/or opinions of the researcher(s) and/or faculty member(s) and do not reflect the University’s official stance.

In Nov. 2012, Missouri voters passed a ballot measure that prohibits the adoption of a state-based health insurance exchange without legislative or voter approval, which led to Missouri missing the Nov. 16 deadline established by the Affordable Care Act (ACA) to set up a state health insurance exchange for 2014.  More importantly, the ballot measure also restricted the ability of state agencies to work with the federal exchange that will be established for Missouri.  Bridget Kevin-Myers, a research assistant professor in the University of Missouri Truman School of Public Affairs and senior legal analyst in MU’s Institute of Public Policy, has concluded that the ballot measure, as enacted, could have detrimental effects on the functionality of a federal insurance exchange.

“Missouri agencies, their employees and officials will be exposed to potential litigation if they assist, cooperate, or provide any resources to any department, agency or employee of the federal government related to a federal exchange or a federally facilitated exchange, without the requisite enabling law prescribed in the recent ballot measure,” Kevin-Myers said. “This broad legal standing measure, with the attendant financial restraint, could create a chilling effect and may make any individual employee or official understandably leery and less willing to cooperate with a federal exchange.”

In a report submitted to the Missouri state legislature, Kevin-Myers reviewed potential issues that could arise due to the recently passed ballot measure. She determined that a potential chilling effect could be problematic because, due to the ACA, a federal exchange will be created in Missouri with or without action from the Missouri legislature. Missouri state law requires all health insurance policies offered in the state to be approved by the Missouri Director of Insurance. However, Kevin-Myers says that because of litigation concerns that state officials may have, there may be very few, if any policies from the federal exchange may be offered to Missourians.

Kevin-Myers also concludes that the recent ballot measure passed by voters in November could ultimately cost Missouri taxpayers money. She says there is a good chance that the new law could spark a federal law suit arguing that the ACA trumps any state law, and could lead to a lengthy and expensive court battle.

The Missouri statute, as it stands, is not likely to survive a federal pre-emption claim,” Kevin-Myers said. “Missourians may be required to fund futile litigation to defend a statute that is likely to be struck down. As envisioned, the insurance exchanges, state, state-federal partnership or federal, will increase competition, transparency and availability of insurance to a segment of the population that has historically not benefited from competition-decreased price with better offerings and quality.  Without enacting an enabling statute, state employees and officials may be unwilling to cooperate with a federal exchange out of fear of legal repercussions. This reticence will undoubtedly affect any insurance offerings to Missourians on a federal exchange.”

To view Bridget Myers’ full report, visit:

Established by the University of Missouri Board of Curators in May, 2001 the creation of the Harry S Truman School of Public Affairs represents a major commitment to public affairs education, research, and public service by the University of Missouri. The mission of the Truman School is to advance the study and practice of governance in Missouri, the nation, and the world by conducting research, informing governance and public policy, educating for ethical leadership, preparing the next generation of scholars and fostering democratic discourse.