Mo. senators debate health coverage plan for uninsured

Tuesday, April 22, 2008 | 4:15 p.m. CDT; updated 11:49 a.m. CDT, Thursday, September 3, 2009

JEFFERSON CITY — After its flashy debut fizzled out, Gov. Matt Blunt's Insure Missouri proposal made a comeback of sorts today as senators debated legislation that eventually could subsidize health insurance for as many as 200,000 lower-income Missourians.

The legislation is intended to help working Missourians who currently lack health insurance. The state would pay their insurance premiums, as long as the participants put up to $1,000 a year into health savings accounts to help cover their insurance deductibles.

Although it contains elements of Blunt's original proposal outlined in September, the legislation is modeled after a new Indiana law that offers a similar health insurance subsidies for people earning up to twice the poverty level.

Blunt announced in February that he was canceling the spring startup of his Insure Missouri plan because of opposition among lawmakers. Some House members had questioned Blunt's legal authority for the program, its cost and its scope.

Since then, House and Senate committees each have crafted their own versions of a government-subsidized health insurance program. With only a month left in the session, today marked the first time either proposal received debate by a full chamber, though the Senate was largely empty for much of the discussion.

"I thought the governor had his heart in the right place," even though his original proposal faltered, said Sen. Tom Dempsey, R-St. Peters, the sponsor of the Senate legislation.

But Sen. Joan Bray, D-St. Louis, suggested that Dempsey — like the governor — still was missing the mark. That's because the legislation would not guarantee coverage to all the thousands of people booted from Medicaid by budget cuts in 2005.

"This governor and Legislature pulled the rug out from under a lot of people in 2005 on their health care," Bray said. "I think we have a moral obligation to those poor people who are economically underprivileged to do something for their health care. And this plan, doesn't do it."

About 170,000 fewer people are enrolled in Missouri's Medicaid program compared with spring 2005, before the cuts and eligibility changes took effect. In the year following the Medicaid cuts, the U.S. Census Bureau said, the number of Missourians without health insurance grew by an estimated 104,000 to a total of 772,000 — a rise three times the national growth rate.

Dempsey contended the proposal for subsidized health insurance would affect more people than simply restoring the Medicaid cuts.

Similar to what Blunt proposed, the legislation would provide health insurance for working parents earning up to the federal poverty level, which is $21,200 for a family of four.

People earning up to 225 percent of the poverty level, or $47,700 for that same family of four, could receive subsidized coverage if they contribute to a health savings account. The bill would require them to contribute up to $1,000 annually, or a maximum of 5 percent of their income, according to a sliding scale.

The insurance plans would provide at least $500 of preventive care per year, regardless of whether participants had met their insurance deductibles.

The program would be limited to people between the ages of 19 and 64 who have been without health insurance for at least six months and do not have access to affordable health insurance through their employers.

Almost all of those details are similar to the Healthy Indiana Plan, which began in January.

The Missouri Senate legislation also includes several other provisions. It would restore physical, occupational and speech therapy benefits to people enrolled in Medicaid and establish rating system guidelines for the quality and cost of health care services.

It would dedicate $5 million annually from Missouri's share of a national tobacco settlement to go toward anti-tobacco programs, beginning in 2009. The bill also would create several health care pilot projects, and it would reward five employers a year with commemorative plaques for achieving official state recognition as "the healthiest place to work in Missouri."

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