Legislating health care

Of the many bills filed in the Missouri legislature concerning health insurance, seven bills show some promise of making it to Gov. Matt Blunt's desk for his signature.

State Rep. Nathan Cooper, R-155th District, says the top priority among lawmakers is SCS/SB 577, which would enact the Mo HealthNet Division. It will essentially be the new Medicaid.

The bill will update the current Medicaid legislation, which runs out June 30, 2008. Cooper said one of the major changes is that the new legislation will focus more on wellness and in "finding a health care home," diminishing the users' dependence on emergency rooms for non-emergency medical treatments and making it more profitable for more physicians and other providers to participate.

Living a healthier lifestyle may not be the answer to everyone's health problems, Cooper said, but under the new law, those who do will be rewarded by additional health care benefits that may not be otherwise covered under the plan.

"It would be opened up for people who are working to achieve a plan set forth by themselves and their provider," he said.

The providers will be accorded incentives to accept more patients, Cooper said, "not that they're unwilling to see them, but they need to be not losing money. With this plan, at last they can cover their costs by seeing these patients."

Also included in the HealthNet plan is funding to establish a 24-hour, toll free, confidential nurse health line participants can call when they have symptoms, before visiting an emergency room or urgent care facility. The registered nurses who participate will not diagnose, but will advise when it would be best to seek treatment and make other recommendations.

HCS HB 818 will add flexibility to the portability of health insurance, bringing it into compliance with HIPAA, the federal Health Insurance Portability and Accountability Act.

Proponents of the bill say it is a step toward improving accessibility of insurance by providing equitable tax treatment for small businesses with the provision for a premium-only cafeteria plan, allowing more portability of insurance plans, promoting individual ownership of plans and encouraging continuity of care.

Opponents say that several items still need to be considered, including the necessity of subsidies and premium offset programs, the impact of the purposely uninsured population, the transparency between health benefit plans, markets and carriers; mandatory participation requirements and how to properly cede risk into the high-risk pool.

Senate Bill 3, modifies provisions relating to mental health, Cooper said. It sets fire safety standards, that stem from an incident in Southwest Missouri involving a sheltered workshop. For this reason mainly, Cooper said, the bill has a good chance of passing.

Other aspects of the bill include defining who is a "vulnerable person," strengthens sex offender notification, and increases the penalty for a mandated reporter not reporting abuse and neglect. It also gives civil immunity to Department of Mental Health employees and providers who engage in discussion with intent to help ensure that facilities and providers are aware of past history of potential employees that might create a danger to clients, and increases the penalties for community providers who do not correct problems cited during licensing inspections.

House Bill 39 will change the way sheltered workshop employees must spend down their assets under the federal Ticket to Work and Work Incentives Improvement Act.

"Currently in the Medicaid program if the employees have income of certain amounts, they have to spend that amount before Medicaid kicks in," Cooper said. "If they have a high spend-down, or any spend-down, the incentive to work is not very great. This allows the individuals who are disabled to go to work and not be hindered by spend-down provisions."

House Bill 353 will increase fraud penalties for Medicaid.

House Bill 40 allows people who buy premiums for long-term care to deduct the total cost from their income taxes.

Cooper says he has either already voted in favor of some of these bills, or will vote in favor of them, although he is still researching the portability issue prior to casting his vote.

"These are a good representation of the bills out there," Cooper said. "We understand health care is an issue that will not be going away. Costs keep increasing and dealing with this issue is something we have to do in the foreseeable future."