This article first appeared in the St. Louis Beacon, Nov. 11, 2011 - For more than three hours, the Missouri Senate's Interim Committee on Health Insurance Exchanges heard pleas from dozens of people who beseeched the panel to support or oppose setting up a state exchange of competing insurance plans that could be tapped by small businesses and individuals.
Thanks in part to an organized effort by pro-health care groups and labor unions, most of Thursday's speakers were strong supporters of the exchange -- a contrast with the committee's members, who were predominately Republicans wary of the idea.
Some of the pro-exchange speakers, or those submitting written testimony, were people like Nancy Linder of St. Louis, who testified that they can't obtain health insurance because of pre-existing conditions. Exchanges could expand access and lower costs, she and allies said.
Others were affiliated with businesses or insurers. Mary Jo Condon of the Business Health Coalition said its members are largely self-insured companies that believe that a state exchange could help lower their costs and expand coverage.
Dave Smith, director of governmental affairs for Anthem Blue Cross Blue Shield of Missouri, told the panel that all the major insurers in the state want to see a state-created exchange because they believe that the state legislature would have more control if it set up the exchange. Smith also cited the federal dollars available.
The pro-exchange crowd came armed with hand-held signs -- "Tell the Truth'' and "Affordable Healthcare Now" -- that were raised in unison when speakers said something that exchange supporters liked or opposed.
But one of the pro-exchange leaders, former state Sen. Joan Bray, D-University City, was candidly pessimistic that the parade of pleas in favor an exchange would sway the panel. As she stood in the hall after delivering her own remarks, Bray observed, "I think they are so far down the road of being against the federal health-care law that they're politically indebted to the opposition."
Exchange a Flashpoint in Partisan Battle
At issue is whether the Missouri General Assembly agrees to set up a state exchange, which would allow the state to access tens of millions of federal dollars or if it will decline the money and opt out.
If the state declines to set up an exchange by January 2013, the federal health-insurance law approved in 2010 calls for the federal government to step in and unilaterally create a Missouri insurance exchange.
Although the Missouri House overwhelmingly approved a state exchange last spring, the state Senate blocked the idea. During the special session, several senators -- including Jane Cunningham, R-Chesterfield, and Jim Lembke, R-Lemay -- crashed a meeting of the Missouri Health Insurance Poll, contending that the volunteer board was improperly preparing to accept $21 million in federal money for initial activities in preparation for a state exchange.
That backdrop offered context for Thursday's hearing on the campus of Lindenwood University in St. Charles. The session was the third of four scheduled hearings; the last is set for next week in Springfield, Mo.
Cunningham, who also sits on the Senate panel, politely challenged the assertions of some pro-exchange speakers that its creation would lower health-care costs.
Committee chairman Scott Rupp, R-Wentzville, said Thursday's hearing was the first where advocates organized such a large presence, making up more than three-quarters of the audience packing the auditorium.
Most of the minority were tea party activists who have been vocal in their opposition to exchanges or any other aspect of the federal health-insurance law pushed by President Barack Obama and his Democratic allies.
Representatives of anti-abortion groups, notably the Missouri Right to Life, said they remain adamant that any insurance policies offered by the exchanges not cover abortion; anti-abortion groups also want to bar the exchanges from even allowing purchasers to buy separate riders covering abortion with their own money.
Dennis Denny was among health-insurance brokers who believe their businesses would be decimated by an exchange. Denny advocated that legislators wait to see if the 2012 elections elect enough Republicans in Congress, and perhaps the White House, to repeal the law and the exchange requirement.
St. Louis lawyer Ed Martin, a Republican candidate for the 2nd District congressional seat, exhorted the Senate panel to oppose any aspect of what he called "Obama-care.''
Martin's comments touched off the crowd's only "boos."
While Rupp said he wasn't swayed by the organized showing of the pro-exchange crowd, he said he was pleased that there were no altercations between the two camps.
Several speakers, on both sides, came up afterward to praise Rupp for allowing everyone who wanted to speak to do so.
Rupp said the hearings are being held to inform senators and the public. The Senate panel, he added, will not be taking a stand on exchanges and won't make a recommendation to the full Senate.