Haley’s Department of Health and Environmental Control has made fighting obesity in South Carolina a number one priority. The director of the agency has formed a state obesity council to pull together all the organizations around the state working on the issue to learn from each other and better coordinate efforts.
If that state were running its exchange, it could say to insurers ‘We want to make sure you have a plan that encourages diet and exercise.’ Medicaid frequently does this. The program is always tailored to the specific needs of the state. By ceding the prerogative on their exchanges, states lose the opportunity to make those choices.
Of course even if South Carolina did run the exchange, it is probably unlikely that it would have dictated anything to the insurance carriers given its past reluctance to regulate anything about the insurance industry.