EXPANDED MEDICAID IS NO EASY CURE

There is little question that keeping people healthy through preventive care is much less costly than treating serious illnesses brought on by a lack of proper medical attention. But the fact remains that many Missourians don't have medical insurance and, as a result, wait too long for expensive treatment.

Under legislation approved this year by the Missouri Legislature and recently signed into law by Gov. Mel Carnahan, some 90,000 young Missourians under the age of 19 will have access to Medicaid coverage. The governor called the legislation -- the Children's Health Initiative -- his top priority this year. The new law allows the state to dip into $51 million of federal funding for medical care, along with $20 million of state funding approved by legislators.

Although the intent of the costly new initiative sounds lofty, the fact remains that far too many children won't have access to medical care no matter how much state and federal money are thrown at the problem. The governor's starry-eyed optimism that more than $70 million will fix the problem overlooks the stark reality that too many doctors won't take Medicaid patients even with this new program.

Two areas of Missouri are hardest hit by the lack of medical professionals willing to take Medicaid patients. One is Southeast Missouri, and the other is the northeast quadrant of the state. These are both largely rural areas, and they are areas with large numbers of individuals and families who fall well within poverty levels.

Of course, the Children's Health Initiative broadens that category considerably. Now families of four with annual income of nearly $50,000 can qualify for the new Medicaid coverage, if they are unable to get private insurance or if the private insurance costs more than $86 a month. Many group-insurance plans offered by businesses and companies in Southeast Missouri require employees to pay far more than $86 a month for family coverage.

Dropping these company plans for the less-expensive Medicaid coverage would have several drawbacks. For one thing, the state would make these families go without coverage for 30 days before being eligible for the Medicaid plan. Families with young children assume a large financial and health risk by not having any coverage for a month.

And then there is the problem of where such families would get medical care under the Medicaid program. Although 468 health-care providers in Southeast Missouri accept Medicaid patients, most of them limit the number of welfare patients. And for practical reasons too. The Medicaid reimbursement schedule is so low that doctors, dentists, optometrists and other health professionals must leave room in their appointment books for patients who can afford to pay or have good private-insurance coverage.

The notion that this new program has somehow boosted health care for thousands of young Missourians is sadly ill-conceived. Moreover, this multimillion-dollar welfare program has taken away much of the incentive for private insurers to come up with their own programs for dealing with those who can't afford good health care.

Once again, government's ever-expanding grab to be all things to all people is likely to have more negative impact than positive outcome.