Insure Missouri bill finally filed
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Insure Missouri bill finally filed

Date: March 13, 2008
By: Rebecca Beitsch
State Capitol Bureau
Links: HB 2398 HB 2413 SB 1283 HB 2354

JEFFERSON CITY - After months of deliberation, Missouri Republicans have filed legislation to implement the governor's proposed Insure Missouri to expand government-backed health care coverage for more Missourians.

But the various bills that have been filed go quite a bit further than the governor's original idea, even including provisions to establish requirements for school physical education courses.

The first bill to be filed using the phrase "Insure Missouri" would provide health care to an additional 150,000 people not covered by MO HealthNet, said the bill's sponsor, Sen. Tom Dempsey, R-St. Charles County. The bill, however, makes the exact number of people covered subject to the legislature's annual appropriation.

The bill is designed to provide health care to people who make up to 225 percent of the federal poverty level whereas MO HealthNet (Missouri's old Medicaid program) covers only those under 100 percent of the federal poverity level . To be eligible, a person must also be age 19 or older but under age 65 and that are not eligible for health insurance under their employer. An applicant may not have had health insurance for the past six months.

The bill would provide tax credits to small employers to provide insurance to their employees.

Funding for the program would come from the court settlement with the tobacco industry, settled about a decade ago. 

Missourians who apply for the program would be required to contribute a percentage of their income, anywhere from 1 to 5 percent, to a health savings account used to purchase their own private insurance. Any money left over at the end of the year could be applied to the next year.

Dempsey said the savings-account provision would give people a greater responsibility over their own health care.

"When you're spending your own money and making a contribution, there's a lot greater awareness of what you're spending it on," Dempsey said.

Sen. Wes Shoemyer, D-Clarence, said that going from a public insurance type to a private insurance type may create problems. The senator said he is concerned that people will not be able to get care from the same providers.

In addition to providing insurance, the bill also incorporates a number of preventative measures. Dempsey said a number of those without health care are forced to turn to the emergency room, which passes the financial burden on to the state.

The bill includes a measure to make physical education mandatory in schools from kindergarten up to senior year of high school, said Dempsey, who cited a study that found students did better on tests if they had daily physical activity. The bill also sets up a smoking cessation program and allows people to use their health savings account on dental and vision care.

Bob Quinn, the executive director for the Missouri Association for Social Welfare, said he's glad the legislature is dealing with the health care issue in the state and thinks it's a good first step.

"As long as when it's passed you don't say, 'Well, we're done,'" Quinn said. "We just want to work with them to expand it to make it better."

An official with the administration's Social Services Department agreed. Jan Carter, the department's special assistant to the director, said the department wishes the program covered more people, but approved of the broad focus of the program.  

Senate Democratic leader Maida Coleman, D-St. Louis, did not have so many words of praise.

"I never thought it was a good idea from the beginning," said Coleman, who said she is irritated that the medical community has been so supportive of a bill that she says is "not in their best interest."

"The medical profession succumbed to supporting this due to the governor's power," Coleman said. "Now that the governor is not running for re-election, those that are pushing this should do the right thing and step away from it."

Coleman said Democrats are not satisfied with the bill because they would like to see a bill that takes the state back to the pre-2005 levels, before about 100,000 were cut from Medicaid under a budget-cutting plan pushed by Gov. Matt Blunt.

Rep. Judy Baker. D-Columbia, also expressed reservations.

"We need to address the problem of the uninsured, but we need a sensible way to do that," Baker said. "I hope legislation will address the elderly and the disabled first and then move to working families. It's a matter of priorities. I think we could do it all if our resources were redirected."

The Missouri Budget Proposal, an advocacy group, would also like to see more people covered. An organization official expressed "grave concerns" about working families' ability to afford the proposal.

Ruth Ehresman, the director of Health and Budget Policy for the group, said they were concerned about populations that may be ineligible, such as working families, those who receive child support and people who are not working but caring for family members.  

Although the legislative session is at its midway point, Republican leaders voice determination to get a bill passed.

"Some version of it will move this session," vowed the Senate's GOP leader, Charlie Shields, R-St. Joseph.

But among Republicans in the legislature there are major differences in what approach to take. In addition to Dempsey's Senate bill, House Republican leaders have filed their own "Insure Missouri" plan that would redirect some insurance taxes to finance a system to expand health care coverage for the lower income through the private insurance market.