Mo. Senate defeats attempt to restore some Medicaid cuts

JEFFERSON CITY, Mo. -- Senate Republicans defeated an attempt Tuesday to restore government health-care coverage to tens of thousands of low-income parents who were cut from Missouri's Medicaid rolls two years ago.

The vote came as senators debated a proposed Medicaid overhaul that would change the program's name and the way health care is delivered, but would leave unchanged most of the 2005 cuts.

Since its peak of just over 1 million enrollees two years ago, Missouri's Medicaid rolls have dropped to about 825,000 people -- largely a result of stepped-up eligibility checks and harder-to-meet income qualifications.

Democratic Sen. Victor Callahan, of Independence, sought to restore Medicaid coverage to an estimated 37,000 parents whose incomes are well below the poverty level.

But the Senate rejected his amendment 18-12, with just two of the majority-part Republicans -- Sens. Kevin Engler of Farmington and Jason Crowell of Cape Girardeau -- joining the Democratic minority in support of it. Four senators were absent.

Callahan estimated his amendment would have cost about $58 million while expanding Medicaid eligibility for parents to an income level that still would have been less than what was in place before mid-2005.

Republican lawmakers and Gov. Matt Blunt cited the growing costs of Medicaid when cutting eligibility two years ago. Blunt describes those cuts as a first step in Medicaid reform.

Senate Majority Leader Charlie Shields, R-St. Joseph, who is sponsoring this year's legislation, argued that Callahan's amendment would have undercut the bill's effort to encourage more businesses to offer private health insurance for their employees by letting those businesses instead rely on the Medicaid system to cover their workers.

His legislation would authorize the state to offset part of the private-sector health insurance premiums of employees who have been uninsured for a year. Further details, such as the amount of money people could receive, would be worked out by the Department of Social Services.

But Callahan noted the legislation stops short of forcing employers to provide health insurance for their staffs. He argued it was better to make sure those 37,000 workers would be covered by the government than to wait to see whether they would actually get private insurance.

Besides offering incentives for private insurance, the legislation also would provide incentives for people covered under Medicaid to try to be healthy. If they keep doctor's appointments and follow a health improvement plan, for example, they could get credits on an electronic debit card that could be used for over-the-counter drugs or health club dues.

Doctors and other medical providers also would face new performance incentives, earning more money by showing a history of good patient outcomes.

The revamped Medicaid program, dubbed "MO HealthNet," would match patients with "health care advocates" who would help coordinate their care. It also seeks to spread more elements of a managed-care insurance system to Medicaid patients around the states.

Families USA, a Washington, D.C-based health care advocacy group, raised concerns about the bill Tuesday. With the economy improving, the group said Missouri lawmakers should restore coverage to those who lost it two years ago.

But "from what we have seen so far, we think there is reason to be concerned that this legislation will be a big step backwards," said executive director Ron Pollack.

Moving more elderly and disabled people, who have complex health care needs, into managed care might not be a good approach, said Families USA, which suggested a pilot project before a statewide implementation of the new plan.

The group also expressed concern that health care advocates could serve as a hindrance -- not a help -- in the doctor-patient relationship and that the effectiveness of personal health incentives are virtually untested nationally, being implemented so far in only a few states.