House and Senate differ on health coverage for Missourians

Monday, April 6, 2009 | 12:01 a.m. CDT; updated 11:26 a.m. CDT, Thursday, September 3, 2009

JEFFERSON CITY—A Senate-approved plan to provide health insurance to nearly 35,000 low-income Missourians is facing stiff opposition from members of the sponsor's party.

The proposal, sponsored by a Senate Republican, won preliminary approval from the Senate Wednesday. But in both the Missouri House of Representatives and Senate, other Republicans are voicing opposition.

The GOP-controlled House already said no to Gov. Jay Nixon's insurance plan for children earlier this year, and last year it rejected a modified version of former Gov. Matt Blunt's proposal to expand Medicaid.

The plan before the Senate this year is the so-called "son" of last year's Insure Missouri, which would have given insurance to 200,000 people. That bill died in the House last session when Healthcare Transformation Committee Chair Rob Schaaf, R-St. Joseph, stalled action on the bill. Schaaf is not a fan of this year's legislation either.

This year's bill, titled "Show Me Health Coverage," would insure low-income parents who earn too much to qualify for Medicaid, but must be within 21 to 50 percent of the federal poverty level. For a family of three, that means earning less than $10,000 a year. Funding for the bill comes in the form of $52.5 million in uncompensated care funds, given to hospitals by the federal government for treating uninsured patients in the Emergency Room.

The bill is sponsored by Sen. Tom Dempsey, R-St. Charles. His bill has the support from members on both sides of the aisle, although not all Republicans.

"Obviously the Senate is in a different mood than the House when it comes to reinstating health care," said Sen. Wes Shoemyer, D-Clarence. Shoemyer said he was proud to be part of a body that expands health care at no cost to the state, and looks forward to sending the bill to the House. "I'm ready to give them a chance to redeem themselves," Shoemyer said.

Two House members say the bill represents a fundamental difference between the two bodies. Rep. Doug Ervin, R-Holt, sponsored his own health care expansion bill that would provide insurance to people who have difficulty getting insured because of outstanding health problems. He said Dempsey's bill covers a population that is cheap to insure because it is proven to be healthier.

"The Senate wants to throw money at the healthy uninsured to reduce the number of uninsured. It's a political move, something politicians do to make themselves feel good simply because they're reducing a number," said Ervin. "My bill actually expands access. These people actually have conditions that need to be covered rather than trying to cover the cheapest population."

Dempsey said both he and Ervin have a passion for reducing the number of uninsured and that he'd like to see both bills pass. But Dempsey said Ervin's views of the health of the population his bill would cover is "anecdotal at best."

"What we've seen in states like Indiana, that uninsured population, to say they're well is a stretch," Dempsey said

Dempsey said Indiana has found the groups it sought to cover had greater need for health care coverage than originally thought.

Both Schaaf and Ervin accused Dempsey's bill of using tax payer's money to fund special interests, particularly the Missouri Hospital Association. "I'll tell you what this is," Schaaf said. "This bill is $50 million of tax payer money going straight to an interest group."

Dempsey said because his plan uses federal funds designated for the treatment of the uninsured in the ER, the program would not need state funds, and all of the money will go straight to providing treatment to 34,800 uninsured.

"The point is to get them out of the ER and to a primary care physician. It's better for them, and it's better for the state."

One senator called the bill a "Chia pet" and questioned whether uncompensated care funds would be enough to sustain the program in years to come. "He's planting a seed," said Sen. Jason Crowell, R-Cape Girardeau. "Then next year he'll come back and ask for $25 million, and the year after that for $50 million," Crowell said.

Despite criticism from Crowell, Dempsey said he believes the Senate sees the benefit of covering the uninsured.

"Both the House and the Senate are concerned about establishing a new program that would burden the state," Dempsey said. "But the Senate sees a public and budgetary benefit in covering this group."

The fate of Senate-proposed health care legislation could be highly influenced by which committee it is assigned to in the House. The bill could go to Schaaf's committee or the Health Care Policy Committee chaired by Robert Cooper or the Health Insurance Committee chaired by Kevin Wilson.

Schaaf refused to bring the bill to the floor last year unless a hospital expansion point was addressed. He said he will do the same this year because the Senate has not put forth any market-based solutions for transforming health care.

It is not certain, however, that Dempsey's bill would again be assigned to Schaaf's committee if it clears the House.

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