Blunt postpones startup of new government health-care program

JEFFERSON CITY, Mo. -- Yielding to legislative concerns, Gov. Matt Blunt on Friday scrapped plans to start a government-subsidized health insurance program for the working poor next month.

Enrollment had been scheduled to begin next week for the governor's "Insure Missouri" plan. It was projected to expand health coverage to about 54,500 low-income parents when its services were to begin March 14.

But a bipartisan House committee had sought to block it from taking effect. Lawmakers had raised concerns about Blunt's legal authority to start the program, its cost and its scope. Some feared a big bureaucracy; others complained it wouldn't have covered enough people.

"I do not believe it would be fair to sign citizens up for a program that may not be renewed by the legislature," Blunt said in a written statement Friday.

The Republican governor said the House had requested more time to try to reach a consensus on Insure Missouri. He set a new goal of starting it sometime after the next budget year begins July 1.

If the Legislature does pass something, it's unclear if it will resemble the program Blunt proposed. The program may keep the same name, but its details may be significantly different.

Rep. Rob Schaaf, chairman of a House health-care committee, has been the most outspoken Republican critic of Blunt's plan. He envisioned an alternative Friday that could extend coverage to those who cannot get insurance -- either because of health problems or cost -- while also improving the quality and cost of health care for those who have private insurance.

"We want to truly transform health care, we want to cover more people, we want to encourage people to be healthier, we want to encourage them to get insurance," said Schaaf, R-St. Joseph.

'Fundamentally flawed'

Democratic Rep. Sam Page, a physician from St. Louis, criticized Insure Missouri as "a fundamentally flawed plan." Among other things, he said it would have forced people in rural Missouri into managed care plans that haven't worked there.

Also, "it did nothing to address access for kids, people with disabilities and seniors," Page said, "and that is the population that was hurt worst by the governor's cuts" to the Medicaid system in 2005.

The U.S. Census Bureau has estimated that 772,000 Missourians lack health insurance.

Over the course of five years, Blunt had sought to extend health coverage gradually to 189,787 people at an ultimate annual cost of $952 million. The plan would have used existing state and federal tax revenue to subsidize private health insurance, similar to the managed care policies already in place for some of Missouri's Medicaid recipients.

When Blunt announced his plan last September, some lawmakers were taken aback because it went far beyond the pilot project they had included in a 2007 bill for the state to pay a portion of the private insurance premiums of some low-income Missourians.

Blunt's administration decided that was unworkable and instead relied on a provision in a separate budget bill to try to launch the Insure Missouri program.

Several weeks ago, most of the members of the House Special Committee on Healthcare Transformation sent a letter to Secretary of State Robin Carnahan asking her not to publish the proposed rule needed to start the program in mid-March.

Carnahan had not yet made a decision when the Department of Social Services on Friday withdrew its request for the emergency rule. The department said it was doing so to allow additional comments about Insure Missouri.

Blunt's plan had the support of various interest groups, including the AARP, the Missouri Hospital Association, Missouri Primary Care Association and Missouri Association of Rural Health Clinics.

It also was backed by the Missouri Budget Project, a group that analyzes fiscal policies for their affects on the poor and has frequently criticized Blunt on other topics. Executive director Amy Blouin expressed disappointment about Blunt's decision to pull back the program.

Talking to media Thursday at the Governor's Mansion, Blunt acknowledged the legislative concerns while saying it was conceivable the program's startup could be delayed.

"There are indeed members who wisely don't want to rush into any new initiative," Blunt said. "In fact, many of the members who are asking the questions are people who I am in sort of ideological sync with. They're asking the sort of questions that I would ask about Insure Missouri."