State lawmakers pass bill to expand health insurance

JEFFERSON CITY, Mo. -- Some of the roughly 700,000 Missourians lacking health insurance could find it a little more affordable to get. But people who don't pay their medical bills could lose their state income tax refunds under legislation sent Friday to the governor.

The legislation is touted as a way to expand access to private health insurance and to let people carry their individual insurance policies with them when they take a new job.

The bill also addresses a growing liability for hospitals and other medical providers who treat patients who can't or don't pay.

The House gave final approval to the bill 106-41, a day after it cleared the Senate 31-0 with little discussion.

Later Friday, the Republican-led House also voted 91-56 along largely partisan lines to approve a massive bill revamping the government-run Medicaid health care program for the poor. But the House bill must be reconciled with a significantly different Senate version if lawmakers are to send a final bill to Gov. Matt Blunt by the May 18 end of their session.

The private health insurance bill would expand the eligibility and lower the premiums for people to be covered by the Missouri Health Insurance Pool. The government-supervised program was created in 1991 to provide private insurance to people who cannot get or afford it, often because of chronic health problems.

About 3,000 Missourians currently are covered under the high-risk pool, according to Department of Insurance, Financial Institutions and Professional Registration.

Sen. John Loudon, R-Chesterfield, who handled the bill in that chamber, estimated 10,000 to 20,000 people could be covered as a result of the expanded eligibility.

People covered under the high-risk pool presently pay premiums 1.78 times the standard rate, but current law allows that to go up to twice the standard rate. Under the bill, people covered under the high-risk pool could not be charged more than 1.5 times the standard rate.

The insurance department estimates the bill would cost the state $7.5 million next year, growing to $25.2 million by the 2010 fiscal year.

The bill also would allow people to keep their individual insurance policies when they take a job with a small business that provides a group health plan. Instead of paying for that employee's participation in the group plan, the business would pay an equivalent amount that could be used for the individual insurance premium.

Sponsoring Rep. Doug Ervin, R-Kearney, touts health-insurance portability as one of the most important parts of the plan.

Another supporter, Rep. Tim Flook, R-Liberty, predicted the bill would cause an "avalanche of change" that would "disrupt the [insurance] marketplace in a very good way."

But some House Democrats expressed concern about a provision that would allow the state to deduct money from people's income tax returns and lottery winnings to cover debt owed to hospitals and other medical providers. The state could keep a cut of up to 20 percent of the collected amount.

Reps. Margaret Donnelly, D-St. Louis, and Rachel Bringer, D-Palmyra, both lawyers, expressed concern that there were few legal protections for patients accused of not paying.

"We are setting up this state bureaucracy to go after these taxpayers who may or may not owe this debt," Bringer said.

Republicans defeated a motion by Donnelly that could have sent the bill to a negotiating panel to come up with a different version.

But negotiations appear certain for the separate bill that would rename Medicaid as "MO HealthNet," place a greater emphasis on preventative care, restore some of the health services cut two years ago for Medicaid recipients and raise the amount the state pays to doctors who treat Medicaid patients.

"This is really true reform," said Rep. Rob Schaaf, R-St. Joseph, a physician handling the bill in the House.

A version passed previously by the Senate would not restore as many Medicaid services nor mandate the physician rate increase and instead would place a greater emphasis on moving Medicaid recipients toward managed health care.

House members approved an amendment Friday that could make all Medicaid recipients subject to random drug testing.

They defeated 78-68 an amendment that would have restored the 2005 eligibility changes, which forced thousands of low-income parents, disabled and seniors off Medicaid and also led to fewer children being covered.

The 2005 changes were made to help balance the budget. But Democrats note that the budget for next year leaves a $200 million surplus, which they contend should be spent to restore Medicaid cuts.

House Budget Committee Chairman Allen Icet, R-Wildwood, said that "would bankrupt the state" in future years.

Arguing that this year's Medicaid bill does little to help people, Rep. John Burnett mockingly proposed to change its name to "NO HealthNet." His amendment failed on a largely party-line vote.

"It is dishonest to represent to the people of Missouri that we are fixing Medicaid when all we are doing is putting a new label on it," said Burnett, D-Kansas City.

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Health insurance bill is HB818.

On the Net:

Legislature: http://www.moga.mo.gov