Crowell sketches new state health plan

~ His idea is to allow small businesses to form alliances to purchase health coverage.

State Sen. Jason Crowell, R-Cape Girardeau, testified at the capitol proposing drastic changes to Missouri's health-care system. Crowell's proposal would allow small businesses to form alliances for the sole purpose of purchasing health coverage for their employees, it would also create a "health-care financing authority" state trust fund for individuals without coverage.

Crowell unveiled his "I-Care," plan (short for individual access to health care) on Tuesday. He said the plan which has not yet been proposed as legislation will provided more portable and efficient health-care.

Crowell said he did not set out with the intention to overhaul the system, but he soon discovered that drastic changes were necessary.

"I realized when I was looking to make changes that if you pull on this string it causes an effect over here, and if you pull on that string it changes something else on the other side and everywhere else," he said. "So as I started to address my concerns I decided we needed to change the whole delivery system."

He said the problems with the system require aggressive changes.

Crowell's plan is modeled on Cross Trails Medical Center where, he said, people pay for care according to their means. "They take private pay, Medicaid and no pay," he said.

In order to make these changes, Crowell decided he needed to increase the pool of the insured from which the state would finance its trust fund, comparing it to a divided hundred dollar bill. "If you and I had to come up with $100, we would pay $50 each, but if 100 of us got together then we'd only have to pay $1 each," he said.

With an eye on similarly dividing the burden, Crowell's plan would include all state employees including the University of Missouri under the consolidated state plan. MU currently purchases its own plan for some 38,500 employees, retirees and dependents.

By lumping MU employees with higher-risk groups, the plan would almost certainly raise premiums for those currently under the MU umbrella. University officials are opposed to Crowell's plan.

"This is an issue that has come up more than once over the years. Thus far we don't support the concept of combining the university's health plan with that of the state. We do not believe that combining the plan would be in the best interest of our employees," said Joe Moore, a spokesman for the MU system.

Concerns also arise that health care is not madatory for small business owners under Crowell's plan. Many small business owners with lower-risk employee populations would not voluntarily participate in the proposed plan, which might raise their premiums. A 2003 study by the national Government Accountability Office showed that in states offering Employer Health Alliances the alliances account for less than 5 percent of the small-group enrollment. Many of those groups enroll because they are high-risk. The result is higher overall rates for the system.

Massachusetts Republican Gov. Mitt Romney recently made headlines by requiring every citizen to purchase some sort of health care in an effort to avoid the high-risk/low risk divide.

Crowell said Romney's plan has merits and that he's leaning towards supporting something similar. That will be a question for the General Assembly to answer, he said.

A 2005 study by the Missouri Foundation for Health showed that of the 700,000 people with no health insurance, more than 80 percent were employed or the dependent of someone who was employed. Meanwhile, 282,000 uninsured workers were employed by firms with less than 100 employees.

"Instead of being focused on how much we spend on Medicaid, let's put into place a system where the individual is empowered," said Crowell. "I know numerous individuals in Cape Girardeau with a Medicaid card, but they can't go see a doctor, and they can't go see a dentist. That doesn't make sense...the model we have now is not focused on the individual. We live in a world where 401(k)s travel with the individual, pension plans travel with the individual, car insurance travels with the individual. Why not health care?"

Crowell's plan is one of three recently to focus on Missouri's growing population of working uninsured. The other two proposals are sponsored by state Sens. Timothy Green, D-North St. Louis County, and Joan Bray, D-West St. Louis County. Both pieces of legislation seek to expand small business coverage.

tgreaney@semissourian.com

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