COLUMBIA — Republican gubernatorial candidate Kenny Hulshof on Tuesday outlined his proposal for a voluntary government-administered health savings plan all Missouri residents could buy into, regardless of income or employment status.
In the proposal, the state would pay insurance premiums and subsidize the health savings accounts. Participants also would pay an unspecified amount for their plans.
Hulshof announced his health-care policy plan, called Healthy Missouri Access Exchange or HealthMAX, during a news conference on Tuesday morning at Boone Hospital Center's Missouri Heart Center. He said the plan, which he would phase in over five years, would cover about 500,000 Missouri residents who lack health insurance now.
If approved, the state would adopt the program to include the state work force of about 60,000. Hulshof said state workers would automatically switch over to the new program once it's adopted, though they could opt out at any time. Most state employees and retirees are covered by the Missouri Consolidated Health Care Plan.
With state-sponsored savings accounts, HealthMAX participants would have access to up to $500 for regular check-ups and routine doctor visits. Participants who had money left over at the end of the year could either cash it out or roll over the balance into the following year's account.
Hulshof's plan would be available not only to individuals but also to businesses.
"We are trying to help small business owners get out of the health-care business," Hulshof said.
Small businesses could name HealthMAX as their insurance provider and continue to make comparable contributions to their existing employee health insurance plans. Participants, however, would own their accounts and would be able to maintain the same coverage plan if they are fired or get a different job.
Hulshof estimated the program will cost about $50 million with "a couple of million dollars" from the state for administrative fees. Hulshof didn't identify a specific source of funding for the plan but he said he hopes to free up $45 million in the general revenue fund by ridding the Missouri HealthNet Division of inefficiencies. Later Tuesday, Hulshof campaign spokesman Scott Baker clarified that the total cost of the proposal is estimated at $590 million annually. Most of the rest would be paid for by redirecting money that currently goes to hospitals to offset part of their costs of treating the uninsured, he said.
Missouri HealthNet purchases and keeps track of health-care services for low-income Missourians.
Although the state would administer the program, maintenance of HealthMAX information and data would be up for bid to corporations such as Google or ehealthinsurance.com, Hulshof said.
The plan would not discriminate on the basis of applicants' pre-existing conditions, or health problems. Those who take part in HealthMAX would be given a debit card to provide for medical costs.
Residents who fall just outside the upper limit of eligibility for direct state aid would be eligible for tax incentives for the purchase of HealthMAX plans. The measure, Hulshof said, would cost the state $10 million to $20 million. Those incentives would be based on income and whether the applicants had been insured before, he said.
As part of his health policy proposal, Hulshof said he would use Missouri's share of the tobacco settlements to help Missourians quit smoking, which he did not explain.
Hulshof said in developing HealthMAX, he looked at other states' plans, particularly Massachusetts' mandated health-care plan. However, he said he distanced his plan from that state's because of its requirement that all residents have some type of health insurance.
In a separate initiative, Hulshof proposed working with hospitals, clinics and doctors to create a network of electronic medical records.
While seeking his party's nomination during the primary campaign, Hulshof spoke on the general importance of health-care policy but had not outlined a detailed plan. Until Tuesday's announcement, Hulshof's campaign Web site outlined his stand on health care in three sentences: mainly promoting doctor-patient relationships, preventative care and affordable health care while "maintaining accountability to taxpayers."
Democratic gubernatorial candidate Jay Nixon, on the other hand, has outlined a plan that primarily calls for repealing Medicaid cuts made by Gov. Matt Blunt in 2005. Nixon announced his plan on July 22.
Nixon's plan offers to cover the thousands of Missouri residents who were cut from the program's rolls.
Hulshof criticized Nixon's plan on Tuesday, calling it an "old-fashioned idea: ‘Let's put them back on the government rolls.'"
In a statement responding to Hulshof's proposal, Nixon campaign spokesman Oren Shur said Hulshof's proposal would not reduce the number of Missourians without health insurance or drive down the cost of insurance. He also said Hulshof's proposal would effectively turn down "hundreds of millions of federal health care dollars each year."
Nixon's plan allows families with incomes up to 300 percent of the federal poverty level to buy their children's health insurance through the States Children's Health Insurance Program, or S-CHIP. For 2008, the U.S. Department of Health and Human Services poverty guidelines define the poverty line for a household of four as $21,200. This line is used to determine eligibility for financial assistance through federal programs.
About 64,000 Missouri children who are eligible for the S-CHIP aren't enrolled in the program, according to an August report by the St. Louis Post-Dispatch. Nationwide, the program, a state and federal partnership, extends health-care coverage to about 6.6 million people, most of whom are children. On Aug. 15, the Bush administration was backing down from a plan to withdraw federal funding from states that offer coverage to children in families above 250 percent of the poverty line, according to the Associated Press. Had the regulations taken effect, Nixon's plan would have been in conflict.
Nixon, also ,said he wants to set up a Show-Me Health Consumer Web page that would allow Missourians to compare prices, benefits and billing methods for a variety of health-care plans. Hulshof said he likes the idea of transparency in health-care costs and indicated he, too, would try to establish a Web site.
The Associated Press contributed to this story.