HEALTH CARE REFORM LIKELY HOUSE DEBATE

A health care reform bill, so controversial the sponsor attached an amendment to change the bill number, likely will be debated on the floor of the Missouri House this week.

Not even the strong support of Gov. Mel Carnahan and the sponsorship by powerful House Speaker Bob Griffin was enough to overcome massive controversy that clouded House Bill 1622. Not only did Griffin find out no Republicans were likely to support the plan, he also was advised by many Democrats they wanted no part of the legislation.

Griffin made some changes in the bill to get it out of committee. But before it was brought up for debate on the House floor last week, the speaker made major alterations in his bill that primarily focused on health insurance reforms.

With about three dozen amendments offered from both sides of the aisle, Griffin is spending the weekend sifting through the stack to see which ones he could accept when debate resumes.

Most area legislators say they still are uncertain whether they can support the bill. But all agree they are much closer to supporting it than they were last week at this time.

"It is awfully hard to predict what will occur," said Rep. Mary Kasten, R-Cape Girardeau. "The bill has certainly come a long way from where it was. There are many areas that need to be corrected in health care, but we don't need to re-do everything."

Added Rep. David Schwab, R-Jackson, "I thought it was interesting how many changes they did make to get support. But I'm not sure they have enough support yet for us to pass anything. It's amazing how much they cut out of there, which shows how little support they had for the original bill."

Schwab expressed some disappointment that what is left will not address the escalating costs of health care. "There is nothing in there that I can see to really control costs. Actually, now it is just a bill to regulate insurance companies," said Schwab.

Even with the changes, Schwab says more changes are needed for the bill to get his vote.

Rep. Dennis Ziegenhorn, D-Sikeston, said Griffin made a smart move by amending his bill to renumber it as HB-2000. He believes such a change is necessary to help legislators and constituents understand that the 100-plus page bill that 1622 was, is now down to about 18 pages.

"I think it was a smart move because 1622 had become such a household bad word. I think it was a great idea," said Ziegenhorn. "I've never seen it done in my 14 years here.

"Even if 1622 had been amended down to what 2000 is today, I don't think you would have enough time this summer running for re-election to defend what 1622 was," he added. "You would almost have to vote against 1622 because of the number, regardless of how modified it was. I have never seen word get around as fast around the state about a bill in my 14 years."

Ziegenhorn said much of the information going out is inaccurate, but there is no way to change the perception of what is in the bill.

"HB-1622 is a dead bill, but it's brother is alive," he said.

Since the number has been changed, Ziegenhorn said it is essential that the controversial items taken out don't show up in the bill later.

"I think right now if we could push the button the bill would pass," he said. "But it could become a bad bill in a hurry with all the amendments that are out there. One bad amendment could really mess a bill like this up."

Rep. Mark Richardson, R-Poplar Bluff, agrees with his colleagues that the bill has undergone a substantial transformation from when first proposed. But he believes House Republicans oppose it and that more than a dozen Democrats won't support it.

"I think the bill is in serious trouble," Richardson said. "It is certainly not dead by a long shot, but in its present form will need major revisions before any Republican will support it. Beyond that, there will have to be some significant changes before a considerable number of Democrats support it.

"If the bill survives, it is going to be a bill that can be classified primarily as insurance reform. We will have to move away from the issue of more government involvement, more government power, to determine the choice of health care providers and methods that providers can use."

Richardson said conservative Democrats and Republicans still have concerns about the bill creating a greater role for government in health care and mandating universal health care by Jan. 1, 1997.

"Even though our worst fears that were present in the original 1622 have been deleted, the distinct flavor of the bill simply puts us on a pathway to those concepts and mandates, and clearly represents a philosophical shift in that direction," said Richardson.

The end result is that even a modified bill could set the stage for implementation of the controversial reforms taken out of the bill in the future.

Among the components that remain in the bill are ensuring portability of health insurance coverage, allowing some form of guaranteed coverage for pre-existing conditions, setting up some types of basic coverage plans to be chosen from, and some type of community rating system.

Richardson said there is support for a modified community rating plan that takes into account gender, geography, lifestyle issues and age.

Schwab is concerned about the community rating portion of the bill that exempts businesses with 500 or more employees, including the state.

"If it is not good enough for the state, why force it on small businesses and individuals around the state?" Schwab said.

Richardson also supports a plan to provide individual medical accounts, similar to an IRA, so people can save to pay their deductibles on health insurance policies.

Kasten and Ziegenhorn both said there are reports the Senate will not even take up the bill if it passes the House. Also, Senate Majority Leader J.B. "Jet" Banks has a bill that has passed the Senate which he believes is the best way to go on health care. However, the governor opposes that version.

"The bill passed by the Senate is more appealing to some of us," Kasten said. "I just wish we could look at some insurance reforms and then study this during the summer now that all the issues have been brought to the forefront. We need to do some good, thorough planning."