JEFFERSON CITY — Missouri's attempt to expand coverage to thousands of people unable to get affordable health insurance has failed.
Some supporters of a 2007 Missouri law projected it would extend health coverage to as many as 20,000 hard-to-insure residents through a mixture of insurance reforms aimed at lowering costs.
Two years later, only about 400 additional people are insured through the plan. And the executive director of the Missouri Health Insurance Pool estimates only half of those are attributable to the 2007 law.
Not surprisingly, Missouri officials are still squabbling over the best way to expand health insurance to at least a portion of the more than 700,000 now lacking it.
Missouri is a microcosm of the debate going on in Washington, where President Barack Obama is pushing for a health insurance overhaul aimed at covering the nation's roughly 50 million uninsured.
The Democratic president insists any legislation must include an option for people to buy into a government health insurance plan. Congressional Republicans, who are in the minority, oppose public health plans that would compete with private insurers. That could make bipartisan agreement unlikely as Obama urges Congress to send him a health care bill by October.
Missouri politicians are in a similar predicament as they consider their next attempt to expand health care to the uninsured.
Democratic Gov. Jay Nixon wants to add low-income parents to Missouri's Medicaid rolls, which were cut by the Republican-led General Assembly in 2005. The Missouri Senate has sought to cover the same group by creating a new government plan with different benefits than Medicaid.
Republicans in the Missouri House prefer government subsidies for lower-income people to buy into the state's high-risk insurance pool if they cannot get affordable private insurance because of their health problems.
None of those proposals passed during Missouri's 2009 legislative session.
That leaves the 2007 measure as Missouri's last health-care expansion law. It was sponsored by Rep. Doug Ervin, R-Kearney, and Sen. John Loudon, R-Chesterfield, whose term expired in January.
One provision of the 2007 law gave people the option to keep an individual health care plan instead of enrolling in their employers' small group plan, allowing employers to make contributions toward those individual health plans.
Another section expanded the eligibility and lowered the premiums charged to participants in the Missouri Health Insurance Pool, a government-supervised program that provides coverage to those who cannot get or afford it, typically because of chronic health problems.
Ervin says he envisioned the two sections as linked, with small employers essentially subsidizing their employees' purchase of individual health plans through the state pool.
But the first prong never has been widely implemented. The Missouri Department of Insurance, Financial Institutions and Professional Registration said Friday that it has no authority to issue health insurance regulations for employers, only for insurance companies.
Additionally, there are concerns the Missouri law might conflict with federal regulations, or open employers and insurance providers to discrimination lawsuits if one employee gets a better health plan than others.
Ervin believes the failure of the private sector provision has contributed to the failure of the state-sponsored high-risk pool to significantly expand coverage.
At the time the 2007 legislation passed, the pool covered about 3,000 people. As of the end of the first quarter of 2009, it covered about 3,400 people — far short of the additional 10,000 to 20,000 that Loudon and some others predicted.
Part of the problem is that even with reduced premiums, the state health pool remains too costly for many people. As a result of the 2007 law, the premiums charged under the Missouri Health Insurance Pool fell from 178 percent of the standard private insurance rate to 138 percent.
"I think most people still believe that's more than they're willing to pay," and so have chosen to go without health insurance, said Larry Case, executive vice president of the Missouri Association of Insurance Agents, which represents 560 independent insurance agencies.
His group now supports legislative efforts to lower that ceiling to 125 percent of the standard private market rate.
But even that may not help if consumers are not steered toward the plan.
Although Case contends otherwise, Ervin says "there's really a lack of marketing of the high-risk pool among agents around the state." Ervin says that's because insurance agents get no commission for helping enroll people in the pool — something he would like to reverse.
Loudon also suspects a lack of marketing for Missouri's insurance pool, adding: "It's disappointing people aren't taking advantage of what we did provide."
The health pool's executive director, Vernita McMurtrey, is equally disappointed in the enrollment results. She recently has been reviewing drafts of the potential federal health care legislation.
"If Missouri doesn't come up with some type of program to address the sick, the uninsured and the underinsured, we are unfortunately going to be at the mercy of the (federal) government in dictating to us how to handle our population," McMurtrey said. She added: "It's just a terrible dilemma."