Missouri health care legislation facing new challenges

Thursday, December 18, 2008 | 4:43 p.m. CST; updated 11:29 a.m. CDT, Thursday, September 3, 2009

JEFFERSON CITY — Larry Stephens found out he had lost his Medicaid eligibility when he went to get his motorized wheelchair fixed.

"My friend works at the store, and she went to go pull up my information in the computer. Then she just tells me, 'Larry, your Medicaid is inactive,'" Stephens said.

It wasn't until his caseworker called him that he realized it was no mistake.

Gov. Matt Blunt's 2005 Medicaid cuts took 94,850 residents off the program's rolls. These cuts left another 300,000 people with only partial coverage, according to the Missouri Department of Social Services.

The 2008 Missouri legislative session saw the introduction of Insure Missouri, a program that would have provided health insurance to an estimated 200,000 people. But, the legislation was ultimately held up because of disagreements over hospital expansion.

This session, the real challenge to health care legislation will likely be the state budget shortfall, officials say.

Gov.-elect Jay Nixon's budget adviser has projected that the current budget, which ends June 30, 2009, will have a $342 million shortfall. 

Sen. Tom Dempsey, R-St. Charles County, the sponsor of last session's health care plan, said that tough economic times make social welfare legislation even more costly.

"Even without changing the eligibility requirements, more people will qualify for Medicaid because more people are unemployed," Dempsey said.

The poor economy and strapped budget have also affected how Dempsey will package proposed health care bills. Rather than package all the ideas in one bill, the portion dealing with insurance will be a single bill, titled Show Me Health Care, while other aspects from last year's bill will be filed separately.

Bills making medical records available electronically, providing tax credits for home modification to seniors and the disabled and allowing those who lost their jobs to keep their health insurance will likely also be filed separately. Dempsey said in tough economic times, this will give some health issues a better chance of being enacted into law, even if the larger Show Me Health Care bill does not.

The bill might also face some opposition for the same reasons it did in the  last session. In 2008, the Senate passed the health care expansion bill, but it stalled in the House where the committee chairman — a physician — demanded that the proposal ease restrictions on hospital and medical facility expansion. These restrictions are generally referred to as certificate of need laws.

Rep. Rob Schaaf, R-St. Joseph, refused to bring the bill to the floor last session without addressing legislation that would reform these laws. Schaaf said should health care legislation come his way again without the reforms, he's sticking by his principles.

Schaaf said he believes free market competition is the best way to keep hospital bills down.

"Under Sen. Dempsey's bill from last year the taxpayer would be paying twice, which I would still be opposed to," he said.

Dempsey said he is also working with the Missouri Foundation for Health to provide additional funding for the bill.

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