MISSOURI WATCH: MISSOURI'S FORGOTTEN CONSTITUENCY

The adjournment of this year's first annual session of the 90th General Assembly was, as were its 178 precedents, a joyful occasion, signaling the completion of nearly five months of study, work and political jousting. As has been their custom for many years, Missouri's lawmakers paid tribute to themselves, saluting their unrequited love for their constituents, their achievements and the difficult job that comes with trying to please 5.4 million constituents.

As members rose to salute their accomplishments, there was one subject that wasn't mentioned, except in passing as one or two conscientious legislators took note of unattended business that would certainly deserve more attention in the future than it received in 1999. But as everyone knows, it's more politically correct to note the positive rather than dwell on the negative, even if the negative can endanger the health and well-being of thousands of men, women and children.

As this session closed, no one was claiming any progress in dealing with the problem of uninsured Missourians, a term that is so innocuous that it doesn't begin to describe the plight that is confronted day in and day out by some 760,000 citizens below Medicare age. And barely anyone during any time this session mentioned that the sheer numbers of these uninsured continue to increase, despite what is generally hailed as an age of prosperity.

The increase is so significant because the numbers of our fellow citizens without health-care coverage continues to increase each year, and this year's number of Missourians without medical insurance is 24,000 more than when last year's legislative session adjourned.

The chance these citizens will die without adequate medical care continues to become more realistic with each passing year. Experts in the field estimate that by the year 2009, some 1,040,000 non-elderly Missourians will be uninsured, and their prediction is made even worse in the event of a severe recession in between. As many as 1,220,000 of our fellow citizens could be without health care protection at the end of a decade.

Ten years ago less than a dozen Missouri legislators were suggesting remedies for meeting the health-care needs of the uninsured, citing the lack of coverage by a number that at the time did not exceed a half-million of us. One St. Louis lawmaker spent his entire political career in Jefferson City calling for statewide health protection; he finally retired out of disgust and exhaustion. Nobody could blame him.

The plight of the uninsured extends across America, and the problem has long called for a national solution, but the Clinton White House, and most notably the First Lady, stumbled so badly in attempting to reach a solution five years ago that momentum is still mired in Beltway politics. After the scandal that weakened his ability to resolve grave domestic problems, President Clinton can only consider what might have been had he been less willing to trade leadership for sex.

State leaders have insisted that as Missouri reduced its welfare roles and as more and more recipients found jobs, the state's dangerously high uninsured rates would drop. The problem with this claimed automatic resolution is that it fails to take into account that persons leaving the welfare roles often find work in small companies, which have found employee health plans to be so expensive that they have become the rare exception rather than the rule. Missouri's large minority population makes up the largest uninsured bloc, with this group only half as likely to have insurance as whites.

It is sometimes difficult to know whether Jefferson City is more interested in developing significant employment opportunities for welfare recipients or in decreasing the amount of funding required by the state for Medicaid. In fact there is evidence that officials are as confused about the state's objectives as those of us who comment on them.

No one can be optimistic about any national effort to halt the increasing numbers of uninsured Americans who must treat even a normal illness as a life-threatening challenge. Neither political party has stepped forward with suitable answers and neither party in Missouri seems anxious to tackle what will admittedly be a difficult and expensive health insurance plan.

Have we so lost our way that we are willing to settle for a policy that lets the poor die needlessly?