Missouri Senate approves Show-Me Health Coverage

Friday, April 17, 2009 | 12:01 a.m. CDT

JEFFERSON CITY — The Missouri Senate voted Thursday to provide health coverage to an estimated 35,000 uninsured parents.

The approved measure, Show-Me Health Coverage, would cover parents that earn too much money to qualify for Medicaid but who are unable to afford health insurance. This would specifically cover any parent making less than $9,200 a year and would include those making up to the federal poverty level if they are working. The bill uses federal money currently given to hospitals to cover uninsured emergency room patients.

The bill passed 27-7 and faced opposition from more conservative Republicans who said they were worried the state would end up footing the bill later.

"I would predict, here and now, that we're going to have an honest, honest discussion, not this year, not next year, but the following year when we get off the federal bailout juice that we're on," said state Sen. Jason Crowell, R-Cape Girardeau, who voted against the measure. Crowell said that was when the program's funding would run dry.

But what started out as an inquiry about consistent federal funding turned into a philosophical discussion about a government role in providing universal health care.

"We currently have 830,000 Missourians getting their health care from the state; they're asking their neighbors to pay for it," said state Sen. Jim Lembke, R-St. Louis County. "And what you're advocating is adding another 35,000 people this year, and then, again, the mechanism to expand it further in the future, and I guess where we have a philosophical difference is: Whose role is it — the state's role, the government's role — to provide universal health care? Because I think that's where we're heading with this bill."

The bill's sponsor, state Sen. Tom Dempsey, R-St. Charles County, said he supports market reforms that would bring the consumer into the process but that the free market isn't capable of effectively bringing health insurance to everybody.

"If you had a free market solution, there'd be competition in all the areas where there's a profit," Dempsey said. "What that would leave the hospitals with is the people who can't pay for service. There'd be no competition for people who can't pay for service. Hospitals can't exist in that environment."

State Sen. Eric Schmitt, R-St. Louis County, who voted for the bill, said it was an important first step in reducing costs to the state that the uninsured population creates. "The fallacy of this argument is that these people aren't getting health care; they are," Schmitt said. He said the 720,000 uninsured are the patients who go to an "emergency room where it's 10 times more expensive to treat that person than it would be at a primary care physician. So what we're allowing is we're shifting those dollars from an inefficient way of delivering health care to a place where people can get preventative care; they can focus on wellness."

The bill did not gain the support of two of the Senate's more liberal Democrats, state Sens. Jolie Justus, D-Jackson County, and Joan Bray, D-St. Louis County.

Bray said she would rather see an expansion of Medicaid because "it is the most cost-effective and inclusive way" of insuring low-income people. Bray said she was concerned that those who were not working and whose disability and child support payments disqualified for Medicaid would not be covered under Show-Me Health Coverage.

"I think we need to go back to the drawing board and solve some of those problems ... and get some serious inclusion on low-income people," Bray said.

Conservative and moderate Republicans alike commended the bill's transparency in dealing with medical documents and processes, something Dempsey said would ultimately reduce the cost of medical care. That portion of the bill is aimed at making it easier to access the quality and cost of procedures at hospitals, Dempsey said.

State Sen. Luann Ridgeway, R-Smithville, spoke of a man who died from complications during hip surgery.

"I might want to know who his health care provider was and what hospital he was in before I had hip surgery," she said.

Dempsey said his bottom line is getting the uninsured out of costly emergency room visits and into a doctor's office. "I want it so they can be proactive in their health care, not reactive," he said.

The bill will now move to the House, which defeated a similar measure of Dempsey's in 2008.

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