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RENEE MONTAGNE, HOST:

And the case against President Obama's health care law finally reaches the Supreme Court later this month. Twenty-six states have signed onto that lawsuit against the health care law, including Mississippi, whose former governor, Haley Barbour, had this to say about the law.

HALEY BARBOUR: I do not believe the United States government has a right, has the authority or power, to force us to purchase health insurance any more than in the name of homeland security they could force every American to have to have to buy a gun.

MONTAGNE: So it may come as a surprise that this deeply red Southern state is also moving full speed ahead with a key provision in the law, establishing a health insurance exchange where people can shop for plans online. Jeffrey Hess with Mississippi Public Broadcasting has this report.

JEFFREY HESS, BYLINE: Unlike Louisiana, Alabama, Florida and other Southern conservative states, Mississippi is well on its way to having an insurance exchange ready for operation by the 2014 deadline laid out by the health overhaul law. And that's a good thing, according to Mississippi Insurance Commissioner Mike Chaney, a Republican in his second term.

MIKE CHANEY: There are portions in that act that are good parts. And that part happens to be the exchange. That's not a Republican idea. It is not a Democratic idea. It was a universal idea. It had been around a long time.

HESS: An insurance exchange is an online marketplace that's intended to make it easier for people to compare and purchase private coverage. Last year, after the state legislature couldn't agree on how to set up an exchange, Chaney used a little-known rule to lay the groundwork for an exchange.

CHANEY: And the reason is, it's very simple, is it's important that we have an exchange that's designed by Mississippians, operated by Mississippians for Mississippians. We don't want an exchange from the federal government that one size fits all. What may work in New York State may not work in the state of Mississippi.

HESS: The rule change became law in 2009, a year before the federal health care law passed. It allows the commissioner, without any approval from the state legislature or the governor, to set up an exchange by regulatory fiat. Republican Senator Buck Clarke is from the small delta town of Hollandale, and is the author of the 2009 rule change as well as several exchange bills that failed to pass.

STATE SENATOR BUCK CLARKE: The legislature couldn't come together. The whole thing died. And the insurance commissioner saw a different route to this to get this going. And it's just trying to comply with federal law that's on the books right now.

HESS: It's important to remember, Clarke says, that insurance exchange has long been a popular idea in Mississippi. It had the outright support of Mississippi Governor Haley Barbour well before it was included in the health care law he now opposes. Insurance Commissioner Chaney says Mississippi may appear to be an anomaly in the South but he points out that other states did not have a mechanism for avoiding the political fights that have paralyzed state legislatures across the country.

CLARKE: It appears that I am swimming upstream against the trend of other Southern states, but here is the problem. Other Southern states did not have in place the statutory law that I had in place.

HESS: Many in the insurance industry consider the exchanges a key mechanism to reach new customers and to distribute the federal money that the health law provides to help some Americans pay for insurance. A January study by the Center for Mississippi Health Policy found that a working exchange could help lower the rate of people in the state without insurance from 20 percent to 7 percent. The center's executive director, Therese Hanna, says that translates into 275,000 Mississippians who don't currently have insurance getting it.

THERESE HANNA: And about 229,000 of those would be eligible for subsidies. And we're looking at approximately $900 million in federal subsidies coming to the state because of that.

HESS: With the deadline to file bills in the state legislature passed, it's unlikely that there is anything state lawmakers can do to change the course of an insurance exchange in Mississippi. Even if the Supreme Court strikes down all or part of the federal health law, Mississippi and other states are likely to continue building their health insurance exchange. For NPR News, I'm Jeffrey Hess in Jackson, Mississippi.

MONTAGNE: And this story is part of a project with NPR, Mississippi Public Broadcasting, and Kaiser Health News.

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