LETTERS TO THE EDITOR: INSIDE THE HEALTH CARE TROJAN HORSE

To the editor,

In a recent commentary published by the Southeast Missourian I called Gov. Carnahan's health care plan a Trojan Horse. Given the space restraints inherent to creating clear and concise commentary, I chose to temporarily hold back on what else had not been fully disclosed.

The least understood, the least publicized and just possibly the most important component of state health care reform is not a major part of the Governor's plan at all. The Medicaid "Super Waiver" is waiting inside this Trojan Horse.

A document dated 3/17/94 and coded ISN.XLS was prepared by the staff of the Missouri Department of Mental Health, from a report of the Staff Working Group dated February 14, 1994. The document attempts to explain the preparation of a "Demonstration Waiver" for the Federal Government. This waiver would allow Missouri to test a new way of providing and paying for health care for indigent citizens who require medical assistance.

In addition to the traditional medical care provided Medicaid beneficiaries there are additional proposals to include services for the treatment of long term mental illness, substance and alcohol abuse and developmental disabilities. If approved, the Missouri Division of Medical Services anticipates the "Super Waiver" program could begin as soon as the summer of 1995.

The report further explains the "Super Waiver" includes a recommendation for a single test to Medicaid eligibility -- income less than 200 percent of the Federal poverty level. Current categorical limits (like being elderly and in poverty) and resource limits would not be imposed. Income would become the single test. For a family of four, that equates to annual earnings of around $28,704.

The "Super Waiver" would also replace the fee-for-service system and employ a managed-care approach for Medicaid beneficiaries through the Integrated-Service-Networks (ISNs) envisioned by Health Department Director, Dr. Coleen Kivlahan, the Missouri Hospital Association and Governor Carnahan.

The report goes on to explain, "Nearly all people currently eligible for Medicaid would continue to be eligible, but many others would also become eligible. The current eligible population is projected to double under the 'Super Waiver.' So the 'Super Waiver' will expand access to health care."

While expanding access to insured medical care is of great value to everyone, the consequences have not been clearly evaluated up to now. This new Medicaid arrangement could cost the state of Missouri an additional $1.2 billion dollars. That's 'b' as in billion!

By the state's own figures, Missouri currently spends around $3 billion on Medicaid services. Approximately $1.2 billion is state money matched by an additional $1.8 billion in Federal funds. If the Department of Mental Health report projects a doubling of the Medicaid eligible population, then it seems logical to expect we will also double the Medicaid dollars needed to pay for the medical services used by the increased population.

Given that, Missouri will spend a total of $6 billion or a total of $2.4 billion state money on Medicaid, double the current $1.2 billion.

All of this, not so clearly obvious, is connected directly to key provisions in Governor Carnahan's health care reform. The Health Assurance Plan clearly defines taxes, excuse me, "fees" of 2.5 percent on gross revenue to be levied on hospitals, doctors, insurers and medical professionals in order to help pay for charity care. Also, insurers, HMOs, PPOs and ISNs have been told they "have a societal responsibility to spend 1 percent of revenue on improving community health status." This is more specifically defined in the bill under "CORE PUBLIC HEALTH FUNCTIONS."

In addition, those individuals who are still uninsured after January 1, 1997 shall be, read mandated, enrolled by HMOs, PPOs, HSCs, insurers and ISNs at 50 percent of the established community-rated health insurance premium. These providers shall be required to spend up to 2 percent of their revenue to do so.

Having said all that in defense of my Trojan Horse suspicions, I remain unable to get any straight-forward answers to any questions concerning how the state is going to pay for the potential $1.2 billion increased Medicaid spending.

So I leave it to you. You can either call your legislators and ask about the hidden cost of health care reform or you can write the Division of Medical Services and ask them some tough questions about their "Super Waiver."

Of course, you can always do nothing and wait until the Trojan Horse is inside the gate.

Conrad Meier is State Chairman Health Insurance Committee, The Missouri Association of Life Underwriters.

CONRAD MEIER

State Chairman

Missouri Insurance Committee

Mo. Association/Life Underwriters.