How Obamacare Went South In Mississippi, Part 2

There is a timeless quality to many Mississippi landscapes – and a sense that the problems wrought by poverty in the state can't be overcome.

In the country's unhealthiest state, the failure of Obamacare is a group effort.

Mississippians are all too familiar with the dirge of bleak statistics. During my travels, I often heard, "We know what the rest of the country thinks of us." It would become a point of pride, then, that in 2007, Mississippi was leading a race it wanted to win. That fall, a full year before Obama's election to the White House put national health care reform on the agenda, the governor, Haley Barbour, called up the newly elected state insurance commissioner Mike Chaney, a Vietnam veteran from Vicksburg.

The two Republicans had been friends since college; Chaney had been the rush chairman for Sigma Alpha Epsilon at Mississippi State University when Barbour pledged the fraternity. Now, the governor had an assignment for his old friend.

"He said, 'Chaney, I want you to get involved in something that the Heritage Foundation had talked about,'" Chaney, 70, recalled when I spoke to him at his Jackson office in June. Barbour, a folksy titan who had returned to rule over Mississippi politics after a successful career as a Washington super lobbyist and national Republican Party chairman, had enraged advocates for the poor with a series of stringent new restrictions on Medicaid. Now he was keen to take up the conservative think tank's ideas to aid one portion of those without health insurance: "The largest group of the uninsured in Mississippi when I was governor were the employees of small businesses," Barbour told me. He tasked Chaney with laying out how Mississippi could set up an online marketplace where the state's many small businesses could pool their purchasing power to shop for medical coverage.

The idea, at the time, was seen as a conservative one. It was part of the health reform law Republican Gov. Mitt Romney had signed in Massachusetts in 2006, and Barbour was touting it as an economic development measure. "I went from not liking it, to really falling in love with it," Chaney told me. "You know, like you didn't like the girl in the third grade and you ended up marrying her?"

By 2010, when Congress passed the Affordable Care Act, planning was well underway for a state-based exchange in Mississippi. "We had no elected officials who were against what we were doing," Chaney insists today.

As Chaney pushed ahead—hiring technology vendors, convening committees and holding town hall meetings—he expected minimal interference. In December 2010, more than 100 elected officials, agency heads, business leaders and health insurers had attended a "Stakeholders Summit." Six months later, Barbour wrote a letter to Kathleen Sebelius, Obama's secretary of Health and Human Services, designating Chaney and the Mississippi Insurance Department as the "proper authority" to apply for federal ACA funding to build the exchange. Barbour, a pragmatic dealmaker, made clear his interest came "before President Obama took office and much earlier than Obamacare was enacted," and that his plan would meet "the needs of Mississippi, not what is right for Washington."

Chaney moved ahead swiftly. Over the summer of 2011, with $21 million in federal grants, he hired the firm Getinsured.com to build the state's site—christened "OneMississippi.com"—and held weekly meetings with his team, whom he had instructed to read Landmark, the Washington Post's guide to the health law. ("We bought 20 copies," Chaney told me, holding the book up in his office. "It's a great read.") Blue Cross Blue Shield, which had more than 80 percent of the insurance market in Mississippi, assured Chaney it was in. The Center for Mississippi Health Policy, a non-partisan research group, estimated that 1 in 10 nonelderly residents would be eligible to buy coverage through the exchange and that 230,000 low-income Mississippians would be able to receive federal tax credits, totaling $900 million a year, to help them purchase insurance on the exchange.

At the end of that summer, OneMississippi.com billboards went up across the state at football stadiums—the town squares of Mississippi. "Your One Stop Health Choice," the ads read, next to a picture of Chaney's smiling face. Chaney anticipated federal regulators would approve the site by the end of the year. The website was ready. Mississippi would get something right for a change.

INSURRECTION

While Chaney waited for federal approval, however, the crowd's mood began to sour.

The Affordable Care Act had descended on Mississippi like so many prior federal edicts: as an invasion from the North that fractured along racial lines, stoking grievances that still lingered since the Civil War, Reconstruction and the Civil Rights era. This latest incursion — the health law — gave rise to a vicious rebellion among conservative whites in a state that arguably had the most to gain. In June 2012, after the Supreme Court upheld the law's core principle — requiring most Americans obtain health coverage or pay a penalty — Mississippi Tea Party co-founder Roy Nicholson issued a florid order to the ground troops: "To resist by all means that are right in the eyes of God is not rebellion or insurrection. It is patriotic resistance to invasion."

The Tea party's call to cut federal taxes resonated with Mississippians who have the lowest per capita income — at $33,073 — in the nation. "You're talking about folks who get up at four in the morning and go to work hauling logs or work in a machine shop and come home at night at 6 pm, and their understanding of government is that gap between net pay and gross pay. As far as why [the government] took it, that doesn't compute," Marty Wiseman, a political science professor emeritus at Mississippi State University, told me. Summing up the sentiments broadcast on Mississippi talk radio, Wiseman, a Democrat who is white added, "Then you throw in that 'Muslim' black president up there, and it's like throwing a match on gasoline."

And yet, as much as Mississippi conservatives abhor the federal government, American taxpayers spend dearly to keep the state solvent. Mississippi receives about $3 for every $1 it sends northward to Washington; nearly half of the state's annual budget depends on federal disbursements. "If you cut that out," Wiseman said, "we would cease to be a going concern."

A garrulous giant of a man who prefers suspenders and bow ties, Wiseman, 63, is pained by his state's seemingly pathological hatred of Washington. "It's still hard to explain the old embrace of the lost cause of the Civil War where we came home ragtag, and 'By golly the South shall ride again,'" he said of white Mississippians. "There's a certain resentment that I'd rather live in my double-wide in the country and find a way to make it."

Whites continue to dominate Mississippi's elected elite, despite the fact that Mississippi is home to a higher percentage of African Americans — 37 percent — than any other state. Black residents are spread out among the state's four congressional districts, diluting their political power, and three of the four House members who represent Mississippi are white Republicans. Democrats lost their last vestige of control in 2012 when tea party-backed candidates helped Republicans gain control of both houses of the legislature for the first time since Reconstruction.

After Barbour's term ended in January 2012, the tea party's roots reached the governor's mansion. Phil Bryant, the son of a diesel mechanic who was raised in the Delta, had served as Barbour's lieutenant governor, but his politics skewed harder right. When he was elected, the state tea party jubilantly declared him the nation's first tea party governor, a label he embraced. Conservative activists admired Bryant's uncompromising opposition to illegal immigration, his vows of austerity and his law enforcement credentials — he had been a jailer and deputy sheriff earlier in his career. That he loathed the Affordable Care Act was a given.

Soon after Bryant was sworn in, the Obamacare fuse was lit by the Mississippi Center for Public Policy, a member of a national network of think tanks that reportedly receives funding from the billionaire Koch brothers. As Mississippi's plan for a state exchange garnered national press and became something of an embarrassment for the conservative faithful, the think tank's president, Forest Thigpen, seized the moment to come out against it. The insurrection urged by tea party founder Nicholson was on, and those seen as helping to put the law into place were now considered traitors.

Chaney didn't see the ambush coming.

On the morning of July 12, 2012, just weeks after the Supreme Court had upheld the Affordable Care Act's contentious individual mandate, Chaney was flying to Tupelo in a state plane during a driving rainstorm when his phone rang. It was Thigpen, who was hosting a luncheon in Jackson later that day with the Cato Institute, the libertarian Washington think tank, for some 200 guests, including Chaney. "He said, 'I want to know if you want to make some comments,'" Chaney recalls. "And I said, 'Forest, why would I make comments? This is your meeting.'... I said, 'Let me call you back. We're trying to land here, and we can't see the runway.'" The pilot missed the touch down.

When Chaney returned to Jackson later that morning, the governor phoned Chaney to say he wouldn't be there. "I should have known at that point that I had a problem," Chaney says.
Chaney and his aide were the last two people into the ballroom, and Chaney remembers that the doors locked behind them. Bill Stone, chairman of the Thigpen's board, led the ballroom in a prayer, "Lord, I thank you for today's free exchange of ideas," he said somberly, if not prophetically, according to a video of the event posted on YouTube. "We ask these things in Christ's name."

As forks and knives clinked against plates, in front of hundreds of attendees, Michael Cannon, Cato Institute's health policy director, took to the podium. He insisted Mississippi abandon its exchange. The federal government "is desperate for Mississippi to do its dirty work," Cannon told the audience, and "will do anything they can to bribe states to create them." He then asked the elected officials in the room to raise their hands: "If you took an oath to uphold the U.S. Constitution and you believe this law is unconstitutional," Cannon said, "then, I submit you have a duty to prevent this law from ever taking full effect." The room erupted in applause.

"And at that point, they called me out," Chaney recalled. Boos rumbled through the banquet hall. Caught off-guard, Chaney stood up. "I want to make it clear to you," Chaney told the audience, fuming. "I'm a Republican. I support Romney. If you don't like the exchange, vote in November and replace the man in the White House, and we'll all be happy." Sensing the obvious truth of it all, he sat down.

In his office this summer Chaney lingered over the memory. "They set me up," he said.
Gentlemanly political customs were giving way to something more brusque. Mike Chaney—the former rush chairman at Mississippi State, friend of the powerful Haley Barbour—had been pushed out.

By Sarah Varney

Jeffrey Hess of Mississippi Public Broadcasting contributed to this story.

This article was reprinted from Kaiser Health News with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.