DEBATE ON HEALTH COSTS URGED

Two representatives of the Missouri Health Care Forum claimed Wednesday their group does not have all the answers to the complex problems of health care. They stressed, however, the importance of continuing a dialogue among all groups in the state to ensure a rational approach is taken to find solutions.

Tony Rinehart of the Missouri Chamber of Commerce and Dwight Fine of the Missouri Hospital Association conducted one in a series of community meetings being held around the state to discuss findings of the forum and proposed legislation for the 1992 session of the Missouri General Assembly.

Both stressed the legislation is only a short-term solution and that bringing health care costs under control and addressing the broad range of problems will involve a long-term effort.

Rinehart pointed out that the group has representatives of the health care industry, insurance industry, business, labor and the medical profession.

"We are trying to make this Missouri's action plan, not just the action of one group," he said.

"We see this legislation as short term, because the long term needs to be solved in meetings over the next five to seven years," added Fine. "This is not a short-term project; what we really have here is a blueprint for future action."

During the 1991 legislative session, a bill sponsored by Rep. Gail Chatfield, D-St. Louis, that would have provided for universal health care came within about 20 votes of winning approval in the House. Chatfield will have the same bill this year, and concerns about growing momentum for his plan sparked the formation of the Missouri Health Care Forum.

"I really think the vote last year on Chatfield's bill was a message," said Fine. "They were saying `you guys need to get your heads together and improve the system.'"

Fine said the rational approach is through incremental change to make the system better.

When lawmakers return next year, Rinehart said: "There has to be an option other than universal health care. We're just trying to create a new game ... this is a second approach, an alternative."

He added that while Chatfield's approach could double Missouri's $9 billion state budget, this plan would cost between $15 million and $40 million and be phased in over three years.

One part of the legislative package would be to expand Medicaid coverage to include Missourians with incomes up to one third higher than the current AFDC eligibility standards. It would also allow the state to provide obstetrical coverage to all women with incomes at or below 185 percent of the federal poverty level and to provide coverage to children in such households to the age of 1.

Another part of the bill would be to provide tax credits to small businesses that offer health insurance to employees. In addition, some of the existing health insurance mandates in the state would no longer apply to small employers. For any future health insurance mandates, fiscal impact statements would be required.

Legislation will also focus on providing uniform billing of insurance claims to help reduce the administrative costs for health insurance plans.

The state's Certificate of Need law will also be revised to increase the dollar amount of capital expenditures that have to be approved by the review board.

Other components of the bill would be: a local option tax to help defray indigent care costs of hospitals and doctors; developing pilot projects for such things as determining health care value; provide further incentives to businesses to provide health insurance; and develop ways to make individuals better consumers of health care and to practice healthy lifestyles.

About two dozen people attended the community meeting and the discussion illustrated the complexity of the health care issue and the fact that there are no quick solutions.

Much of the discussion focused on the fact that doctors, out of concern for possible lawsuits, were ordering tests that were expensive and driving up total health care costs.

Fine said one thing the forum is looking at is studying practice variation to identify the kinds of tests ordered in certain instances, so doctors will know whether they are functioning within the norm. Tort reform is another issue to be considered.

"There is too much cost shifting rather than efforts to contain costs," noted one of the participants.

Jim Wente of Southeast Missouri Hospital said that while people talk about trying to reduce costs, when they enter the hospital they only want the very best care immediately.

"The only time cost is an issue is when they get the bill," said Wente.

He added that Southeast Hospital has to write off 35-40 percent of its gross revenue each month because of costs they cannot recover, largely because of Medicare and Medicaid reimbursements that are under actual costs.

"We need $65 million per year to meet our budget, but to get that $65 million we need $100 million," observed Wente.

Rep. Mary Kasten, R-Cape Girardeau, said she agreed with the discussion about putting more responsibility on the individuals and local communities, and the need to work together for a solution.

"We have to assume some more local responsibility because this health care problem has been created by everybody," said Kasten. "We have to quit blaming each other and sit down at the local level and work out our problems."