Blunt's insurance plan suffers setback
25 02 08 - 11:09
By Virginia Young
POST-DISPATCH JEFFERSON CITY BUREAU CHIEF
02/25/2008
JEFFERSON CITY - Ever since Gov. Matt Blunt rolled out his ambitious program to provide health insurance for working parents, members of his own party have attacked it.
The plan was too costly, said House Republicans. The Legislature never authorized it — indeed, never even debated it, they said.
On Friday, five months after he announced his plans, Blunt backed off, avoiding a showdown that was set for today.
The governor said he wasn't abandoning his Insure Missouri plan. But pulling back on the program, which was set to launch next month, was a major setback for Blunt.
Though he promised to work with legislators to retool Insure Missouri, what they pass is likely to be far different from his original blueprint. As a lame duck - he announced last month that he won't seek re-election - Blunt has lost some of his clout.
"The governor just took a beating from the House that he couldn't overcome," said Jorgen Schleimeier, a lobbyist whose clients include medical provider groups.
Blunt unveiled his program with much fanfare at a community health center in St. Louis in September. Long derided for kicking 100,000 adults off Medicaid in 2005, the governor drew praise from activists who represent low-income Missouri residents.
Initially, Blunt's plan would have covered custodial parents below the poverty line - for example, those earning less than $20,650 for a family of four. They would have paid no premiums and no more than $3 in co-payments.
Blunt had already taken bids from insurers to provide coverage, which was to start March 14. He wanted to broaden the program in July to include those earning 120 percent of poverty, or $24,780 for a family of four. They could have been charged premiums on a sliding scale.
Amy Blouin, head of the Missouri Budget Project, which studies the impact of public policy on low-income people, was among those who lauded the governor in September. On Friday, she expressed disappointment.
"Our state has lost an important opportunity to provide immediate and overdue health coverage to 54,000 uninsured, low-income
working parents," she said.
Blunt's strategy ran into two problems: he needed emergency rules to gear up the program, and he needed money to keep it running after the new fiscal year begins July 1. Legislators were throwing up obstacles to both.
Blunt based the program on a line in the current budget authorizing subsidies of private health care premiums for lower-income Missourians.
But legislators said Blunt went way beyond legislative intent by fashioning a $600 million program that would eventually cover nearly 200,000 people.
While most of the funding would have come from federal sources, Blunt wanted $46.8 million in state money for the program next year.
Rep. Rob Schaaf, R-St. Joseph, led the fight to stop it, saying the program was "not a good deal for the taxpayers."
Schaaf said Insure Missouri did not provide private health insurance. Rather, it offered public coverage under the federal Medicaid program.
The Legislature's Joint Committee on Administrative Rules had scheduled a meeting for today to discuss the emergency rules.
By pushing for an emergency action, Blunt could have avoided the normal method to create a new program, which would have required public hearings and would have taken months.
Some committee members worried that people would get insurance coverage only to lose it in a legal skirmish over Blunt's authority.
"That's not a good outcome for anybody," said one of the committee members, Sen. Luann Ridgeway, R-Smithville.
Secretary of State Robin Carnahan was waiting for the committee's recommendation. She could have blocked Blunt's rules by refusing to publish them.
"There are very specific criteria to be met for something to be an emergency," Carnahan said last week. Asked whether she was in a difficult spot, she said: "I see the spot I'm in as following the law."
Schaaf is among about eight Republican legislators who have been meeting privately with Blunt's legislative director, former Rep. Chuck Pryor, to see whether any part of the governor's insurance plan can be salvaged.
Several in the group said they want to focus on people unable to get insurance. Because they often have chronic health problems, they can't buy individual coverage and have no group plan available. As a result, they use emergency rooms, forcing hospitals to shift costs to people with private insurance.
One idea from Rep. Doug Ervin, R-Kearney: beef up subsidies for a state high-risk insurance pool that serves only about 3,000 people now.
"It's not well-known, it's not marketed well, people really have to hunt for it," Ervin said. "We're trying to do something we can afford and we can sustain."
Expanding state-paid coverage for poor adults is also a possibility, though not to the extent Blunt proposed. Some legislators said 85 percent of poverty is a more realistic cutoff.
"This isn't about just covering the most people you can cover," said a member of the working group, Sen. Brad Lager, R-Maryville. "This is about covering the people who are utilizing the system" inefficiently by frequenting emergency rooms.
Blunt, for his part, held out hope that he could resuscitate Insure Missouri.
"Our plan has support from many legislators and from health care advocates across the state, but we need greater support in the House," Blunt said in a statement on Friday.
The Department of Social Services will hold on to the bids from insurers, in hopes that contracts can be signed this summer, said Jan Carter, an agency spokeswoman.
The plan's biggest cheerleader was the Missouri Hospital Association, which sent out statewide mailings, urging people to send supportive postcards to their legislators.
Dwight Fine, the group's senior vice president for health policy, said Friday that he is optimistic the bidding process wasn't in vain. Hospitals worked with insurers to set up networks that could provide care.
"Let's see if we can't break the deadlock and move something forward to implement Insure Missouri," Fine said. "From a provider perspective, if they ask us to be patient, we would be willing to be patient."