By Melissa Dunson

mdunson@joplinglobe.com

Passage of a health-care reform bill designed to take the place of the state’s Medicaid provisions is drawing mixed reactions from legislators and those who work in health-care fields.

Some legislators call it long-needed reform for a broken Medicaid system, while others view the new program as misguided and insufficient.

Gov. Matt Blunt first proposed the MO HealthNet legislation last year, saying it would take the place of the state’s current Medicaid provisions, which are set to end in June 2008.

Ruth Ehresman is the director of health and budgetary policy for the Missouri Budget Project, a nonprofit research group that analyzes how public policy affects low- and moderate-income Missourians. She said in a phone interview that she had hoped the health-care reform would address the needs of the more than 114,000 people who lost their Medicaid coverage during state cuts in 2005. Ehresman said MO HealthNet will not do that.

She said the new program offers some benefits but will restore coverage to only about 10,000 of those who lost their Medicaid coverage. She said the legislation falls short of the label “health-care reform.”

‘A false choice’

Ehresman said other elements of the program will be beneficial to an estimated 90,000 low-income women who receive health services such as annual Pap smears, and screenings for cervical and breast cancer. MO HealthNet also will increase reimbursement to health-care providers as an incentive to increase the number of physicians who treat patients receiving state aid.

But Ehresman said that rather than increasing the services for people who still qualify for Medicaid, the General Assembly’s time would have been better spent finding ways to help those who were cut from the program — or better yet, finding a way to do both.

“That’s setting us up for a false choice,” Ehresman said. “Why should we have to make the choice of either more people or more service?”

Rep. Mike Talboy, D-Kansas City, was on the House special committee that debated the bill. He said he’s angry about the MO HealthNet legislation and what he called the apparent disregard in both the House and the Senate for the people who live with the health-care crisis every day.

“This (health care) is the single largest problem in my lifetime, and we’re not going to do anything about it,” Talboy said. “Restoring 6 percent of the pie is not restoration. It’s not meaningful. We bled these people out (in 2005).”

Prevention and wellness

Proponents of MO HealthNet say the program focuses on wellness, prevention and personal responsibility, and will save lives and money. The system establishes a professional health-care advocate system for every person enrolled and a reward system for recipients who improve their health by earning points. They will get those points through making appointments, getting screenings and reaching health goals set by the patient and the health-care advocate. The points will transfer to credits on a debit card that can be used for co-pays, prescription drugs and other health-related expenses.

Another MO HealthNet provision extends the amount of time children in foster care can qualify for state health-care benefits. Under the current system, those benefits end at age 18. The new measure applies to those through age 21.

Rep. Ron Richard, R-Joplin, said MO HealthNet will give Missouri taxpayers “more bang for their buck” by encouraging people to find the most cost-effective method of treatment and to take steps to stay healthy. He said the legislation isn’t perfect, and the impending end of the state’s Medicaid provisions in 2008 motivated the Legislature to get something passed this session.

“We’re not trying to get them into a system that’s worse than the one before,” Richard said. “We want a good, quality program at the best price. Are we our brother’s keeper? Yes, but I can only do what the people give me the money to do.”

Fiscal priorities

Ehresman, who sat through many of the legislative sessions, said every suggestion for restoring those who were cut from Medicaid in 2005 was met with the question of how the state would pay for it. At the same time the Legislature was concerned about the impact of MO HealthNet on the state budget, Ehresman said, politicians were loading other bills with tax cuts and incentives.

Both Richard and Sen. Gary Nodler, R-Joplin, said bills with tax credits for businesses are crucial for keeping Missouri economically competitive with other states, and that the revenue created from that growth is part of what helps pay for state health care.

“The old Medicaid system was fiscally not sustainable, and the idea to create that same thing is ludicrous. It wasn’t sustainable,” Nodler said. “The whole idea behind HealthNet is wellness. It makes sense fiscally, and it raises the quality of life.”

Jessica Robinson, spokeswoman for Blunt, said the governor is aware of and concerned about the issue of the thousands of Missourians who fall through the health-care cracks. But a real issue, she said, is the rising cost of state-funded health care. Last year, she said, health care took up one-third of the state’s budget — more than education or transportation.

“We’re creating other opportunities rather than just state-funded health care like Medicaid,” she said. “(Blunt) wants to improve the health-care safety net, but we have to address the funding. These are issues that are going on at the national level.”

Michelle Ducre, executive director of the Community Clinic in Joplin, doesn’t like giving handouts, and she said she supports motivating people to take personal responsibility for their health and their futures. But, she said she believes the Legislature failed its constituents this session.

The issue isn’t complicated to Ducre. She said simply increasing the eligibility for state-funded health care that would allow access to basic care would make all the difference in the world. For what she sees as political jockeying, Ducre wonders why she is seeing no community outrage.

“And meanwhile, they (legislators) balance the budget on the backs of the poor,” she said.

Melissa Dunson is the business writer for The Joplin Globe.





Biggest cut



In October 2006, the Missouri Budget Project released an examination of the 2005 Medicaid cuts a year after they went into effect. More than 40 percent of those who were cut were children, according to Ruth Ehresman, director of health and budgetary policy for the Missouri Budget Project.