By Paul LeVotaAs a gubernatorial candidate Matt Blunt repeatedly promised not to cut Medicaid eligibility. One of his first acts as governor was to champion eligibility changes that resulted in 180,000 fewer Missourians, including 70,000 children, receiving health care coverage than when he took office. Ever since, Gov. Blunt has been trying to undo the damage to his re-election prospects through impressive sounding but superficial proposals that fail to undo the damage to those kicked off the health care system.
The governor’s first attempt was this year’s so-called MO HealthNet bill. Although trumpeted by the governor as a sweeping reform, its most significant changes simply renamed Missouri’s Medicaid program and the state agency that runs it. Rather than restoring health care to Missourians who need it, the bill actually imposed new bureaucratic barriers to coverage.
Heading into a gubernatorial election year, the governor now has announced his Insure Missouri proposal, which he claims would extend private health insurance coverage to 200,000 Missourians by 2010. Given the administration’s record on health care to date, the plan should be viewed with substantial skepticism.
The plan would pay for private insurance subsidies by using money currently paid to hospitals for providing emergency room care to the uninsured. Ironically, the governor added to the flood of uninsured Missourians seeking emergency room care by cutting Medicaid. Even if Insure Missouri’s optimistic coverage estimate is achieved, more than 500,000 Missourians would remain uninsured, with many continuing to rely on emergency rooms for their only access to care. Therefore it is questionable if Missouri hospitals can absorb the reduction in indigent care reimbursement over the long haul.
The shift in taxpayer-funded health care from Medicaid to private insurers also would result in a dramatic and wasteful increase in overhead. Whereas a mere 4 percent of the money spent on Medicaid goes for administrative costs, such costs account for a whopping 25 to 30 percent of premiums in the private market. Missouri could more efficiently use taxpayer money by restoring Medicaid eligibility to at least 100 percent of the federal poverty level.
The major deficiency is the proposal wouldn’t cover the sickest and most vulnerable Missourians -- children, the elderly and the disabled. And since the governor’s plan relies on providing coverage through health management organizations, it also ignores rural Missouri, where there is little HMO penetration.
House Democrats know that the best, most affordable to taxpayers and most efficient way to improve health care access in Missouri is to undo the governor’s damaging 2005 health care cuts. Shaky schemes built on uncontrollable factors and overly optimistic claims that fail to benefit the most vulnerable Missourians simply won’t hold up.
Last week House Democrats announced part of health care agenda for the 2008 legislative session. Key proposals include reversing the state’s Medicaid cuts and establishing a new Missouri Health Policy Authority. We made these announcements at a series of press conferences through out Missouri at medical facilities in Kirksville, St. Joseph, Springfield, and Scott City.
Although the state a $320 million general revenue surplus in the current budget, the governor says Missouri can’t afford to undo his damage. Yet restoring Medicaid eligibility would cost $155.8 million in general revenue – less than half of the surplus – and allow Missouri to leverage an additional $265.3 million in federal Medicaid funds that instead is going to pay for health care expansion in other states.
Ironically, the very reason we have a surplus is because the governor cut health care. You don’t leave money sitting in the bank when you have bills to pay, and right now Missouri isn’t paying its health care bills.
Streamlining a disconnected bureaucracy is another element of the health proposals in House Democrats’ Moving Missouri Forward legislative agenda for 2008. Based on similar efforts successfully implemented in Kansas, we propose establishing a Missouri Health Policy Authority to oversee and coordinate the state’s role in health care. By establishing this authority Missouri for the first time would have a team of health care professionals directing policy and ensuring efficient use of taxpayer resources.
While streamlining government’s role in health care is important, even the most efficient system is of little use if it isn’t accessible to the people who need it. Today, 180,000 fewer Missourians have access to health care than did nearly three years ago when Gov. Matt Blunt took office and enacted his devastating Medicaid cuts. The restoration of those cuts remains Priority No. 1 for House Democrats.
By reversing the governor’s health care cuts and streamlining government health care bureaucracy, House Democrats have a plan to put the state on the pathway to health coverage for all.
Paul LeVota, an Independence Democrat, is the Missouri House Democratic.
