Insure Mo. plan stalled in House

JEFFERSON CITY, Mo. -- A plan to subsidize health insurance for as many as 200,000 lower-income workers is languishing in the House because of a dispute between some key lawmakers and hospital officials.

House Speaker Rod Jetton said Thursday that the Insure Missouri plan doesn't have enough support to pass the House, and it won't be brought up for debate unless hospitals agree to make it easier for new medical centers to open in Missouri.

"We're stalled on Insure Missouri," said Jetton, R-Marble Hill. "At this time and late day, every day you're stalled is a pretty good chance that the bill is not going to make it."

The session ends May 16.

The Senate gave preliminary approval earlier this week to its own version of the Insure Missouri legislation that does not include an overhaul of the certificate-of-need program used to grant state approval for new hospitals.

Jetton and the House sponsor of the bill, Rep. Rob Schaaf, insist that must be part of the plan to bring it to the House floor.

"We're just not going to take it up unless we can agree to some [certificate of need] reform to make the process more fair," said Schaaf, a Republican physician from St. Joseph.

Without increased price transparency and competition for consumers, "I would prefer to kill it and am willing to do that," Jetton said.

The Missouri Hospital Association, however, is opposed to changing the approval process for new medical centers.

A spokeswoman for Republican Gov. Matt Blunt accused House leaders of trying to spike one of the governor's top priorities. Blunt supports reforms to the certificate process of approving new hospitals, but doesn't believe that should be included in the Insure Missouri bill, said spokeswoman Jessica Robinson.

"This issue is being used as an excuse by members of the House who do not want to expand access to health care," Robinson said.

The hospital organization played a key role in developing the original Insure Missouri proposal outlined Blunt in September. That plan was to have started this spring, but it was postponed because of opposition from Schaaf and other Republican and Democratic House members.

As revised by lawmakers, Insure Missouri would pay the health insurance premiums for people earning up to 225 percent of the poverty level, or $47,700 for a family of four. The participants would have to put up to $1,000 annually into health savings accounts, which would be used to meet their insurance deductibles.

As proposed, the insurance plan would provide at least $500 of preventive care per year, regardless of whether participants had met their insurance deductibles.

The House version of the bill also would revamp the certificate-of-need process used for approving new hospitals, nursing homes and expensive medical equipment.

Instead of requiring applicants to show a need for the new facilities or equipment, as is currently the case, the House bill would create a presumption that the need exists. Opponents would have to prove there is no need or that the new facility actually would cause a substantial and long-term loss of medical services in a community.

The intent is to encourage competition among medical providers, thus lowering the costs for patients, Schaaf said.

But the hospital association contends that wide-open competition could drive hospitals out of business and ultimately lead to poor patient care.

The House proposal could allow physican-owned specialty hospitals to cherry pick lucrative patients by providing only certain services and only to patients who have private insurance, said hospital association spokesman Dave Dillon. That would leave community hospitals treating a greater proportion of uninsured or Medicaid patients, for which they receive less money, he said.

"Supporting Insure Missouri, passing it and implementing it would be a step forward for the uninsured in Missouri, but at the same time, the CON changes would be a step backward, because it would jeopardize the safety net that exists in Missouri," Dillon said.

Added Dillon: "We don't really understand why the two are linked" in one bill.

At some point, all 50 states have had some form of a certificate of need program for medical facilities, said Thomas Piper, the longtime director of Missouri's certificate-of-need program. But some states have abolished the process, leaving 36 that still require it, he said.

All those remaining states require an applicant for a new facility to show why it's needed, Piper said. The Missouri House proposal to reverse the burden of proof is unusual, he said.

"No other CON program in country has even contemplated doing it that way," Piper said.

The House plan also would change the oversight committee for Missouri's approval process. It would remove legislators from the committee and replace them with various economic and medical professionals.

Piper said Missouri is the only state that has lawmakers involved in decisions on whether to grant certificates for new medical centers.