This decision comes in the same week that senators rejected the governor's program to expand health insurance coverage for children, much like the House did earlier this year.
The Senate-approved measure, Show Me Health Coverage, would cover parents that earn too much money to qualify for Medicaid but are unable to afford health insurance. This would specifically cover any parent making less than $9,200 a year and would include those making up to 100 percent of the federal poverty level if they are working. The bill uses federal money currently given to hospitals to cover the uninsured emergency room patients.
The bill passed 27 to 7 but did face opposition from more conservative Republicans who said they were worried the state would end up footing the bill later.
"I would predict, here and now, that we're going to have an honest, honest discussion, not this year, not next year, but the following year when we get off the federal bailout juice that we're on, of actually looking at subject to appropriations as it relates to all allocations of state resources," said Sen. Jason Crowell, R-Cape Girardeau, who voted against the measure.
But what started out as a question about consistent federal funding turned into a philosophical discussion about a government role in providing universal health care.
"We currently have 830,000 Missourians getting their health care from the state; they're asking their neighbors to pay for it," said Sen. Jim Lembke, R-St. Louis County. "And what you're advocating is adding another 35,000 people this year, and then, again, the mechanism to expand it further in the future, and I guess where we have a philosophical difference is who's role is it -- the state's role, the government's role -- to provide universal health care. Because I think that's where we're heading with this bill," he said.
The bill's sponsor -- Sen. Tom Dempsey, R-St. Charles County -- said he supports market reforms that would bring the consumer into the process, but he said that the free market isn't capable of effectively bringing health insurance to everybody. "If you had a free market solution, there'd be competition in all the areas where there's a profit," said Dempsey. "What that would leave the hospitals with is the people who can't pay for service. There'd be no competition for people who can't pay for service. Hospitals can't exist in that environment," he said.
Sen. Eric Schmitt, R-St. Louis County, who voted for the bill, said it was an important first step in reducing costs to the state that the uninsured population creates. "The fallacy of this argument is that these people aren't getting health care; they are. They're the 700-800,000 folks who don't have insurance," Schmitt said. He said these are the patients that go to an "emergency room where it's 10 times more expensive to treat that person than it would be at a primary care physician. So what we're allowing is we're shifting those dollars from an inefficient way of delivering health care to a place where people can get preventative care; they can focus on wellness," he said.
The bill did not gain the support of two of the Senate's more liberal Democrats, senators Jolie Justus, D-Jackson County, and Joan Bray, D-St. Louis County.
Bray said she would rather see an expansion of Medicaid because "it is the most cost effective and inclusive way" of insuring low-income people. Bray said she was concerned that those who were not working and whose disability and child support payments made them too rich for Medicaid would not be covered under Show Me Health Coverage.
"I think we need to go back to the drawing board and solve some of those problems ... and get some serious inclusion on low-income people," Bray said.
Conservative and moderate Republicans alike complimented the bill's transparency in dealing with medical documents and processes, something Dempsey said will ultimately reduce the cost of medical care. This portion of the bill is aimed at making it easier to access the quality and cost of procedures at hospitals, Dempsey said.
Sen. Luann Ridgeway, R-Smithville, spoke of a man who died from complications during hip surgery.
"I might want to know who his health care provider was and what hospital he was in before I had hip surgery," she said.
Dempsey said his bottom line is getting the uninsured out of costly emergency room visits and into a doctor's office. "I want it so they can be proactive in their health care, not reactive."
The bill will now move to the House, which killed a similar measure of Dempsey's last year.