Pre–Affordable Care Act
• 2007: Governor Haley Barbour (R) publicly supports creating an exchange.
• 2008: Two bills to create an exchange were introduced in the Senate, one by Democrat Hob Bryan and one by Republican Eugene Clark. Clark’s bill passed the Senate unanimously but was never voted on in the House.
• 2009: Governor Barbour mentions the exchange in his state of the state speech. Once again, a Republican bill passed with bipartisan support in the Senate but did not receive a vote in the House.
• 2009: The legislature amends the statute governing the Mississippi Comprehensive Health Insurance Risk Pool Association (MCHIRPA) to expand the insurance commissioner’s authority over other state and federal insurance programs.
• March 23: Affordable Care Act (ACA) is signed into law by President Obama.
• September 30: Insurance Department receives a $1 million planning grant.
• November: Mississippi is one of the few states that does not hold legislative elections in even numbered years. However, by the start of the next legislative session, enough Senate Democrats switched parties to give Republicans control of the chamber.
• January–March: Four exchange bills were introduced, three in the House and one in the Senate. Each chamber approved a bill, though a conference committee could not agree on a compromise and no legislation was enacted.
• August 12: HHS awards the Insurance Department with a $20 million level 1 establishment grant. The application outlined plans to use MCHIRPA to create an exchange without legislative approval.
• November 8: Phil Bryant (R) is elected governor. Republicans won full control of both chambers for the first time since Reconstruction in the nineteenth century. Bryant did not focus on the ACA on the campaign trail, but indicated he would continue to support an exchange.
• January: Insurance Department begins holding meetings of an exchange advisory board comprising industry leaders and other stakeholders.
• June 28: The US Supreme Court announces its ruling upholding the ACA and making the Medicaid expansion optional.
• July 11: Tea Party leaders speak for the first time at a meeting of the exchange advisory board. The Tea Party continued to mobilize, subsequently attending meetings of the Personnel Review Board and blocking contracts with exchange vendors.
• November 6: Barack Obama is reelected president. Insurance Commissioner Mike Chaney responds by saying he is ready to submit the state’s blueprint once he discusses it with the governor.
• November 12: Governor Bryant and Commissioner Chaney meet at the Governor’s Mansion, with Bryant saying he will oppose the application and Chaney saying he will submit it anyway. As an independently elected official himself, Chaney believed he did not need the governor’s approval.
• November 26: Governor Bryant writes the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius to oppose the application submitted by Commissioner Chaney.
• January 15: Mississippi Attorney General Jim Hood (D) issues a report agreeing with Commissioner Chaney that Governor Bryant’s approval is not needed.
(p.165) • January 18: Governor Bryant writes Secretary Sebelius another letter, this time criticizing Attorney General Hood’s report and saying that he would instruct the Mississippi Division of Medicaid not to cooperate with an exchange established by Commissioner Chaney.
• February 7: HHS rejects the Insurance Department’s exchange application.
• July 1: Deadline by which Medicaid needed to be renewed. Democrats tried to use this moment as leverage to push Republicans to support expansion. A special session was called in which Medicaid was renewed but not expanded.
• October 1: On the same day that open enrollment begins, HHS approves a plan submitted by Commissioner Chaney for the state to run the small business exchange while the federal government retains control of the individual exchange.