HEALTH CARE AFFORDABILITY IS PRESSING CONCERN

Last November in a special election in Ohio, a relatively unknown Harris Wofford came from way behind in pre-election polls to defeat former U.S. Attorney General Richard Thornburg for a seat in the U.S. Senate.

Most political observers anticipated a relatively easy victory for Thornburg, a former governor, when the campaign began. But Wofford used health care as a central theme of his effort and won by a wide margin.

Although health care is hardly a new issue, many viewed the results in Ohio as a clear indication that people everywhere were sincerely concerned about the issue and the increasing costs of good health care.

The Ohio outcome moved health care from its position as an issue that needed to be addressed some day to its recognition as a priority issue the public wants immediate action on.

All presidential candidates are devoting much of their time to discussing health care, and President Bush and Congress have begun moving toward implementing some type of plan as soon as possible.

In Missouri, health care was identified as a priority problem last year when the Missouri Chamber of Commerce surveyed its members at a series of meetings around the state and discovered it was by far the major issue of concern. The chamber also took note last May, when a bill sponsored by Rep. Gail Chatfield that would create universal health care much like the Canadian system, received more votes than anticipated. The bill came within 20 votes of passing the House.

This was viewed as a sign that legislators were also anxious to consider some type of proposal.

Missouri employers pointed out that health care premiums increased 15.5 percent during 1991, compared with a 16.4 percent increase the previous year.

This increase has forced many employers to drop health insurance coverage for employees, and has left many people without health insurance coverage - both in Missouri and across the nation.

Charles Bowman, president of the Missouri Hospital Association, points out that 600,000 Missourians do not have health insurance and that 30 percent of every hospital bill goes to pay for health care to uninsured people.

"The cost of health care programs is having a major impact on Missouri employers," said Curt Long, president of the Associated Industries of Missouri.

The more people who are without insurance coverage, the greater the costs of insurance coverage are to people who have coverage. This cost shifting is something proponents of health care reform stress must be dealt with in order to make a plan successful.

Last summer, in response to the growing concern over health care, the Missouri Chamber of Commerce and the Missouri Hospital Association brought together a group of people, representing labor, business, insurance, and the medical community, to form the Missouri Health Care Forum.

The purpose of this group was to look at the broad perspective of health care problems and develop a comprehensive plan for dealing with the problems within the present health care delivery system.

Identical legislation was introduced last month in the House and Senate to implement parts of the plan.

"Our package is partly in response to a statewide survey of key issues facing business, and partly in response to legislative proposals to establish universal health care in Missouri," said Jo Frappier, chairman of the Missouri Chamber and co-chairman of the forum with Bowman.

Bowman points out that many components of the legislation carry no fiscal note, yet would considerably reduce costs that are associated with health care.

The plan deals with the dual issues of affordability and accessibility to health care.

The total cost of the plan, phased in over several years, would be about $42 million.

Chatfield's universal health care system has been considered by the House over the last few years. It is modeled after the Canadian health care program, which provides universal access to all citizens through a single payer, the government.

Supporters of this plan point out that it is not dependent upon the continued good health of an individual or on his continued employment. With universal care, supporters say, the costs of bureaucracy resulting from private health plans will be eliminated. Such costs now comprise about 33 percent of the premium cost.

Supporters of universal care maintain that benefit costs would stabilize for employers, in contrast to the unpredictable skyrocketing costs in the private health care market. Individuals would pay a slight tax increase, instead of co-payments and deductibles, which are factors that keep many people from seeking early diagnosis and treatment for problems, they say.

Opponents of universal health care contend that a system providing free care does not encourage any accountability on the part of consumers or adoption of wellness programs and healthy lifestyles.

The universal plan would be funded through a 9 percent payroll tax on employers and an increase in individual income taxes. Opponents of universal care claim the ultimate cost could nearly double the state's present $9 billion budget.

Members of the Missouri Health Care Forum stress that their plan retains the present health care system, which, they say, is already providing the best care in the world. By working within the present system to increase access and control costs, forum members point out that Missouri will be in a good position to react to any long-term solutions that eventually come down from the federal government.

The sponsors of the legislation - Reps. Katie Steele, D-Kirksville, and Phil Tate, D-Gallatin, and Sens. Steve Danner, D-Kirksville, and Jet Banks, D-St. Louis, are optimistic the General Assembly will take action this year to implement a major part of the package.

The bill would require insurers and providers to use uniform claim forms to help reduce administrative costs. All small employer groups would be able to obtain private health insurance, regardless of the risk they present. Neither an employer or insurer could exclude any individual from coverage who had high medical risks. At renewal time, employer groups and individuals in the groups would be assured their coverage would not be canceled because of deteriorating health. The bill also provides for continuity of coverage when an individual changes jobs or the employer changes insurance carriers.

Insurance carriers would also be required to limit how much their rates could vary for groups similar in geography, demographic composition, and plan design; there would be limits on how much premiums could increase; and private insurers would be authorized to write a Medicaid wrap-around policy to allow a low-income woman to be covered by Medicaid in the event she becomes pregnant, but be covered by her private sector insurance policy for all other health conditions.

The legislation would also provide tax incentives to employers who provide health insurance and would establish a way for doctors and hospitals to compare costs of various treatments in an area.