JEFFERSON CITY — While conservatives across the country and the U.S. Senate Finance Committee have rejected the notion of a public option for government health care, more than 15 percent of Missouri's population is quietly benefiting from state-run health coverage programs.
Whether through Missouri's Medicaid program, the State Children's Health Insurance Program or health care cooperatives, the state provides access to health care to a significant portion of its population.
One of the largest public plans is Missouri Consolidated Health Care Plan, which began as a health plan for the workers and retirees for various agencies of state government — including elected officials. The underlying principle behind the program was that state government could negotiate lower per-person coverage rates by offering a large pool.
In 1995, the state opened the program up to local governments as well — a move that has sparked some to encourage opening the program further.
Missouri Consolidated now covers more than 107,000 people.
"It's really a matter of semantics. You could call that a co-op, or you could call that a public option,"said Bob Quinn, executive director of the Missouri Association for Social Welfare, a social services advocacy organization. "At this point, it's a closed entity, just for government, but if you opened that up, maybe to include non-profits and small businesses, no matter what you call it, it could be something that's very helpful to people."
Not-for-profit health care isn't a new idea — Blue Cross Blue Shield started that way — but it is an idea that's garnering more attention.
"Non-profits are good options. In fact, I wish there were more of them, but it doesn't mean the costs are always smaller," said Julie Eckstein, a director with Newt Gingrich's Center for Health Transformation in St. Louis. "It just means the profit stays within the organization for future needs rather than going outside to fundholders."
Co-ops pool the resources of thousands of people, and they often partner with major health care providers for insurance. Over the years, MCHCP has contracted with UnitedHealthcare, Mercy Health System and Express Scripts among others.
Some insurance companies, however, are hesitant to contract with co-ops. Anthem Blue Cross and Blue Shield in Missouri used to contract with MCHCP, but eventually the costs to cover the pool became too expensive, company spokeswoman Deb Wiethop said.
Wiethop said the problem arises when a co-op doesn't attract a mix of both healthy and sick people.
"If all unhealthy people go there because they have no options, then fiscally it's unsustainable," she said.
State Rep. Doug Ervin, R-Holt, a frequent sponsor of health care legislation, agrees.
"It's called a death spiral," Ervin said. "Over time the rates will go up, so the healthy people drop, but the sicker people stay."
Co-ops, state-sponsored or not, have become a significant part of the health care debate. Sen. Kent Conrad, D-N.D., has pointed to Group Health Cooperative in Washington along with other co-ops as an alternative to a nation-wide single-payer system.
Opening MCHCP to small businesses and expanding Medicaid are measures that have all been recently proposed in the state legislature, although none have passed.
Sen. Jason Crowell, R-Cape Girardeau, has sponsored legislation that would have allowed small businesses and other associations to pool together for the purpose of getting insurance, but no action was taken on it after the bill cleared committee.
Another law passed in 2007 expanded the maximum number of employees it takes to qualify as a small business, thus increasing the number of businesses that could take advantage of various incentives for providing health care. However, the law only applies to companies that offer health care.
State Sen. Tom Dempsey, R-St. Charles, repeatedly has sponsored a bill to expand a public option beyond those currently covered under Medicaid. But the plans, Insure Missouri and Show Me Health Care, both died in the last minutes before the end of session. Missouri's Medicaid program — now renamed MO HealthNet — provides health care to more than 850,000 parents, children and people with disabilities.
"The goal is to use existing dollars to provide health care for people who don't qualify for Medicaid," Dempsey said. "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."
To be covered by MO HealthNet, parents must earn less than $4,200 a year for a family of four or 19 percent of the federal poverty level. Families that receive welfare through the Temporary Assistance for Needy Families program can be eligible for MO HealthNet. In order to qualify for TANF, a family of four must earn less than $22,000 per year.
The State Children's Health Insurance Program is available to children whose parents earn less than $66,000 a year for a family of four. The more income the family earns, the more they have to contribute, but premiums are only charged if a family of four makes more than $33,000 per year.
Eckstein, a former director of Missouri's Department of Health under Republican former Gov. Matt Blunt before joining the Center for Health Transformation, was instrumental in drafting legislation with Dempsey to expand health care access to those too wealthy to qualify for Medicaid. Although Eckstein is against a national public option, she said it was necessary to provide access to some sort of coverage.
"I think that in the ideal world we'd always have a safety net for those who can't afford it themselves, but you don't want to stay in that your whole life. It's temporary," she said. "The American way and American dream is to be able to be self-sufficient and achieve for yourself, not living off of everyone else."
Eckstein said the key to expanding coverage is using methods like short-term safety nets and co-ops as part of a nation-wide health exchange, doing for health care what the discount travel Web site Travelocity did for place tickets.
"We want more of an exchange where consumers have the option to chose from a variety of plans. It's not government-run or government-owned, but the exchange lets people look at what are all the options and what's good for them," Eckstein said.