GUEST COMMENTARY: STATE HEALTH PLAN IS BUT A TROJAN HOURSE

At a minimum, I have found nine attempts to disguise what's inside the real health care plan championed by Governor Carnahan. Every example presented here is introduced by the Governor's own verifiable quotes. In rebuttal, my remarks are set in bold type.

1. "Speaker Griffin and I have developed a health reform a health reform plan that reorganizes the way we deliver health care in Missouri."

The plan was actually developed by a team of experts from the University of Missouri School of Medicine and directed by Dr. Coleen Kivlahan, state director of Health and Human Service. The project cost $270,000 and was paid for with state Medicaid funds. The insurance market reforms were developed by the Commission On State Health Insurance and orchestrated by Department of Insurance Director Jay Angoff. There has been no public accounting for any expense.

2. "Health care costs are spiraling out of control."

According to the Consumer Price Index (CPI), the annual rate of increased spending on health care is the lowest it has been in twenty years. Medical inflation fell 6.3 percent in the first quarter of 1993 to a 4.4 percent rate in the second half.

Managed-care and other system reforms have slowed down the inflationary trend to 5 percent faster than the Cost Of Living Index (COLI) in 1991, 4 percent in 1992 and 3 percent in 1993. There is every indication this downward trend will continue to do so without more government intervention.

3. "Our plan requires no tax increases and does not include any employer mandates."

Unless Carnahan cut a secret deal to exempt Missouri from federal law, this statement is completely false. The Governor's plan is deliberately crafted to accommodate the federal mandate requiring 8-percent employer cost-sharing and all the taxes, federal and local, required to finance the additional health care bureaucracies.

State health care reform can be no better than the worst federal mandate eventually passed by Congress. Conversely, if congress actually passes some sensible health care legislation, Missouri will end up with the most radical plan of all the states. This would certainly have a chilling effect on state and local economies.

4. "Health insurance costs for small businesses will go down because small businesses will pay the same rate as large corporations."

My apologies to the Governor, but he has been poorly advised. His own plan exempts all employer groups with more than 500 employees; exempts all Taft-Hartley (union) health plans; association plans like skilled and professional trade groups and all Medicare beneficiaries.

The net effect of all these exemptions reduces the "community rated" pool to less than 40 percent of the state population. It will be the uninsured, the low-income, the small employer and the self-employed that will be left to carry the burden of the Governor's "free-market" reform plan.

5. "Health-care providers will form health-care networks -- called integrated-service-networks...."

The amendment of 3/21/94 removes the state mandate and allows the formation of ISNs on a voluntary basis. Unless the new definition of voluntary is "do it my way or take the highway," the private sector will resist any organization of system that micro-manages medical care and eliminates the physician-patient advocacy role.

6. "...we can achieve these advantages (reform) without any additional revenues."

The Critical Issues Committee amended the bill to raise $300 million a year to subsidize people who lack health insurance. The money would come from a 2.5 percent fee on the gross revenues of hospitals, doctors, health insurance and other providers.

7. "...many special interests in the health-care industry are opposing our plan because they don't want increased competition, don't want to be required to cover pre-existing conditions...."

The Governor must have forgotten it was the insurance industry that supported passage of the small-group health care reform law scheduled to become effective this July. Accepting employees with pre-existing health conditions is a component of that law. His own plan would repeal that law even before it has a chance to prove his effectiveness. And, there is abundant evidence to verify the long-standing support for guaranteed issue portability. For the most part, suggestions from the insurance industry on how to accomplish these goals have been ignored by Jefferson City policy wonks.

8. "The Missouri Health Assurance Plan includes no major new bureaucracies to monitor and govern the system."

There are, in fact, six new government agencies. Starting with the Missouri Health Care Assurance Board we add: Integrated Service Networks; the Health Guaranty Corporation; the Missouri Center for Primary Care Studies; the Medical Information Systems Task Force and the Foundation for Primary Care Trust Fund Board.

Hidden in the health care Trojan Horse is "sleeper bill" HB 1426. This legislation would create a seventh bureaucracy called the Multi-State Health Standards Commission.

9. "The plan we have offered will help Missouri families."

Obviously the Governor fails to understand the consequences of community-rating. The New York Sate Department of Insurance provided me with significant data detailing the disastrous results of their 1993 community-rating law.

The premium for a 30 year old family man went from $1,200 a year to $3,420, or a 170 percent increase. Family coverage for a 45 year old family man increased from $2,520 to $3,240, or a 30 percent increase. Increases for single males and females went up 45 percent on average. Only New York residents above age sixty saw decreases of 30 percent on average.

Given these few examples of misrepresentation used in defense of the state health care reform plan, I can only wonder why there is such a sense of urgency to pass the bill before legislators and consumers understand the consequences?

Rep. Cindy Ostmann, R-St. Peters, clearly identified the problem with the bill and any attempt at revisions: "The bill," she says, "is so badly written no amount of amending can make it viable."

Rep. Ken Jacob, D-Columbia, may have expressed more than one legislators opinion when he said, "A month is not enough time for me to grasp the consequences."

As for this critic, I see a Trojan Horse. The true cost and additional financing needed to accomplish this health care reform agenda is being hidden from view. Except for saying in classic political pitchmanship, "the cost will be paid for by savings", there has been no public disclosure.

Doesn't that bother anyone?

CONRAD MEIER

State Chairman

Health Insurance Committee

Missouri Association of Life Underwriters