The issue will be among the most contentious facing the next legislature.
COLUMBIA — The General Assembly will have its hands full with health care in the 2009 legislative session.
More than 700,000 people living in Missouri don't have health insurance, and one in 12 children have no coverage. Access to preventative care improves the chances people will be healthy, which can lower costs for people across the system.
ON THE WEB
To read more about the health-care issue, and the stances of statewide candidates on the issue, you can read a story by Missourian and Missouri Digital News reporter Rebecca Beitsch here.
If it weren't for the recent economic downturn, health care probably would be the most important issue on the minds of voters, said Dave Dillon, spokesman for the Missouri Hospital Association. Medicaid cuts made by Gov. Matt Blunt in 2005 removed 100,000 people from Medicaid and reduced services for about 300,000 other Missouri residents. Candidates on opposing sides of the aisle are wrangling over whether to restore Medicaid eligibility to 2005 levels, how that would be done and how to account for those who don't qualify for Medicaid but cannot afford health insurance. Costs are a major factor.
Lawmakers face the challenges of finding room in the budget to increase access to health insurance and encouraging the next generation of health-care providers to stay in Missouri to fill the current shortage.
Many agree that access to health care must be expanded. Both major parties differ on how to deliver.
The state legislature can affect policy changes by working together and with grassroots organizations, said Gwen Ratermann, associate director of the Center for Health Policy, a non-partisan policy center at MU. The biggest health-care policy measures to come from Jefferson City have been the ones that cross party lines, she said.
19th District state senator
Chuck Graham, the Democratic incumbent, has said he supports a national universal health-care plan. He said the state must restore the Medicaid system to provide primary care for Missouri citizens, and he criticized Blunt's cuts.
"It was penny-wise and pound-foolish," Graham said. "The Medicaid program is a good value. We basically buy that insurance for 17 cents on the dollar, and right now billions of our federal dollars are going into health care in Massachusetts, Kansas, Illinois and states that are expanding services. Those are our tax dollars."
Graham said the state needs to match funds to receive federal support for Medicaid and "stop giving away hundreds of millions of dollars in corporate tax credits that are out of control."
Republican challenger Kurt Schaefer said the General Assembly needs to have well-established eligibility criteria for people requesting Medicaid to ensure tax dollars are being spent wisely.
"For those people who are in need and don't have health services otherwise, they should have those services provided by the government," Schaefer said. "I think we just need to be very wise in how we spend those tax dollars to fund those programs."
Schaefer said the 2005 Medicaid cuts might have been extreme, but said something needed to be done. He said the General Assembly needs more oversight of health care so it can evaluate every couple of years who receives Medicaid.
"Before 2005, there were hundreds of people still receiving Medicaid who didn't qualify for it," Schaefer said. "They were essentially stealing money from those who needed it."
Libertarian candidate Chris Dwyer opposes forcing insurance companies to take on cases of pre-existing conditions. He said insurance companies should have the right to refuse such coverage to make health care more affordable for the majority.
21st District representative
Incumbent Steve Hobbs, R-Mexico, sponsored a bill in the 2007 legislative session that would increase access to health care in rural areas by offering 50 percent tax credits for private donations to clinics in underserved areas and requiring that the state match half those funds. If re-elected, Hobbs plans to reintroduce the bill. He hopes the legislation will advance in the coming term.
Hobbs hopes to create a model for rural health care in Hallsville and has pushed to restore the clinic there to include the Missouri Telehealth Network, a means of delivering health care over long distances with information technology. Broadening the network, he said, could cut costs and expand the reach of resources.
Hobbs thinks there are better ways to expand access to insurance than by reversing the Medicaid cuts.
Kelly Schultz, a Democrat from Shaw, said the biggest challenge in rural Missouri is finding doctors. Missouri does not fully reimburse health-care providers who treat patients on state assistance, she said.
The current system "means if doctors pick patients in trouble, then they don't cover their overhead," she said. "State assistance will not benefit individuals who have to drive for hours to find health care."
Schultz said she would sponsor a bill requiring stakeholders to sit down to talk about streamlining billing and reimbursements to health-care providers. She said she also would fight to restore Medicaid eligibility.
Funding the programs will take a "change in priorities," she said. "Each year there are 13 appropriations bills where we make choices. We just need to make different choices."
24th District state representative
The candidates agree that Missouri could improve health-care coverage, but they differ on how to do it.
Incumbent Republican Ed Robb is quick to deflate any notion that Missouri can simply refund the entitlements cut by Blunt.
"It's a difficult and contentious issue," Robb said, "but I don't think people realize the amount of money it'd cost to restore" Blunt's cuts. He estimated the cost at about $500 million.
Robb said money could come only from other programs such as K-12 or higher education, or from sizable state tax increases. He doesn't think either of those will happen soon.
"There's this growing belief that health care is a right," Robb said. "Well, you can argue that until the cows come home, but it still doesn't change the fact that this state has to have a balanced budget ... and has to balance its priorities."
Robb's Democrat opponent, Chris Kelly, disagrees.
"Among the first things we should deal with efficiently is restoring health coverage for those people who got cut off," Kelly said.
He said he believes he has the experience and skill to work with a Republican legislature to reverse the Medicaid cuts.
Republicans "tried to stop people from cheating the system by cutting off the people who really need it," Kelly said. "People are still cheating, but there are still people who need coverage."
Kelly thinks fewer people would need the state to pay for health care if small businesses could insure employees. He wants to encourage small businesses to pool together health plans so they would have the same buying power as larger corporations.
"Look how often good employees go to where the health benefits are," Kelly said. "The state should encourage shared pools because it is these small businesses that are vital to Missouri's economy."
25th District state representative
Democrat Mary Still said the first thing Missouri must do is reverse the Medicaid cuts. She is particularly concerned that the recent cuts disqualified Missouri for federal matching money.
"We need to leverage as much of the federal money as possible," Still said. "It stimulates the economy."
Still said that losing the federal funding resulted in some Missouri residents falling into a "downward spiral" of layoffs and bankruptcies. After restoring the basic Medicaid plan, Still said, the state could expand the system to increase access for all Missourians. She also suggested the state allow various groups to buy into the state system. But first, Still wants to see the money from the cuts restored.
"We could begin with that," she said. "There are a lot of pieces of the puzzle to put together."
Still also said an aggressive prosecution unit would cut down on Medicaid fraud. She added that during her time in the attorney general's office, she saw how effective such prosecution can be, particularly if the unit focuses its energy on abuse by large companies.
"People think it's poor people trying to abuse the system," she said. "But it's big companies."
Republican Ryan Asbridge is deployed overseas by U.S. Naval Intelligence and could not be reached for comment.
Missourian reporters Jenn Herseim, Spencer Willems and Hayley Tsukayama contributed to this report.