INSURANCE PLAN FACES UPHILL FIGHT; LEGISLATORS ARE COOL TO CANADA PATTERN

CAPE GIRARDEAU -- A proposal to create a state-run health insurance plan for all Missourians has little chance of passage in this year of tight state finances, area lawmakers said Saturday.

"I am under the impression that considering the economic crunch we are in, it doesn't have much of a chance to pass," said State Rep. Mary Kasten, R-Cape Girardeau.

The plan, proposed by State Rep. Gail Chatfield, D-St. Louis, is patterned after the Canadian health plan and would put a tax increase to a public vote to pay for part of the insurance program.

At a hearing in Jefferson City last week, supporters of the bill said that the legislation would provide badly needed medical care for all residents. Supporters said that currently about 600,000 Missourians have no medical insurance.

Chatfield said the plan would cost more than $9 billion a year, but not all of it would be paid by taxes.

Under the plan, new taxes would go into a trust fund to establish disease-prevention programs, pay health care providers for their services, and develop and maintain hospitals and clinics. The system would be administered by a board of directors made up of state officials and governor appointees.

But Southeast Missouri House members interviewed by the Southeast Missourian Saturday said the price tag alone of such a plan makes it impractical at this time.

"There is no way we can have a state program that will cost more than the (current ($8.2 billion) state budget," said State Rep. Dennis Ziegenhorn, D-Sikeston.

"We (the state) can't afford to take on any more projects that we lose money on," he maintained.

But Ziegenhorn, who chairs the insurance committee in the House, said the inability of many Missourians to afford the high cost of health insurance is a serious problem.

Doctors have joined together in self-insurance pools to provide lower-cost malpractice insurance, and cities and counties have gone that route to obtain affordable liability insurance, he noted.

Ziegenhorn said those insurance pools were developed because insurance companies were not providing affordable coverage.

"I don't have much sympathy for these companies that say they cannot have lower premiums than self-insured groups," said Ziegenhorn.

He said the whole health care issue is a "can of worms." But, he wondered whether some insurance companies might not start providing some needed, lower-cost health care coverage.

"I wish that the companies that provide insurance in the state of Missouri could come up with something (a health insurance plan) as opposed to the state of Missouri coming up with something," he remarked.

Still, Ziegenhorn, who is in the insurance business himself, acknowledged that insurance companies are "in the business to make money."

Ziegenhorn said he had not yet seen the health insurance proposal. However, he pointed out, that the proposal brings back comparisons to the MedAssist amendment.

In November 1988, Missouri voters defeated the MedAssist amendment, which would have enacted a $296 million tax increase to finance a state health care plan.

Some of the money would have gone to doctors, hospitals and health care providers. But most of the money would have been placed in a health care trust fund to provide health insurance for those unable to buy it.

Ziegenhorn said he believes the measure went down to defeat because many voters were opposed to paying for their own health coverage and then paying taxes to fund health coverage for others.

State Rep. Ollie Amick, D-Scott City, said the lack of health care coverage for many Missourians is a concern.

While the poor may receive Medicaid funding, the "near poor" cannot afford the high cost of health insurance and they can't qualify for assistance, said Amick.

"The near poor are those that get caught in the crack," he said. "In other words, they are not eligible for Medicaid and they are either too young for Medicare or Medicare doesn't do a sufficient job for them."

But Amick said the problem is not one that can be addressed on the state level. "Personally, I'm thinking it's going to have to be on a national scope.

"I don't believe the state has sufficient resources to develop a health care plan for everyone in the state," he noted.

Amick said that the legislature is having to wrestle now with how to fund existing state programs in the face of tough economic times.

In such a situation, he said, there is little support for a costly health insurance bill. "I don't see a groundswell of support for it," said Amick.

"I don't see any way that something like that would ever work," said State Rep. David Schwab, R-Jackson.

With the economy in a recession, Schwab said that any measure requiring a tax hike would face considerable opposition from taxpayers.

He also questioned implementing any plan patterned after the Canadian health system.

He noted that under the Canadian health system "there's no incentive" for doctors and the medical industry to provide better health care.

In Canada, he said, it can take six months "to even get an appointment with a doctor."

Kasten, who is married to a physician, called the health care bill "rather extreme."

She said that the Canadian system is not a model on which to base a good health care system.

The Canadian system, she said, "hasn't proven very effective."

Added Kasten, "We have the best health care delivery system in the whole world."

Implementing a Canadian-type system of health care is not the answer, she said. "I think it would deter quality of care for people."

(Some information for this story was provided by The Associated Press.)