The Associated Press

COLUMBIA, Mo. — Republican gubernatorial candidate Kenny Hulshof outlined a long-awaited health plan Tuesday that seeks to expand coverage to the uninsured by making it easier for them to buy private insurance plans.

Hulshof said his “bold initiative” could help low-income parents who were cutoff from Medicaid three years ago, as well as small businesses that can’t afford health insurance for their employees. State and private-sector workers who already have insurance also could choose to use the new program.

Hulshof is calling it the Healthy Missouri Access Exchange — HealthMAX for short.

“HealthMAX is a new marketplace that’s designed to increase access to affordable health care for all Missourians,” Hulshof said while announcing his plan at the Missouri Heart Center in Columbia. “It will be affordable not just for the consumers of health care but for taxpayers in our state.”

Hulshof estimated it would cost $50 million in general state revenues to provide subsidies helping more than 200,000 lower-income Missourians purchase high-deductible private insurance plans used in conjunction with health savings accounts. Others could receive tax incentives, costing up to an additional $20 million, his campaign said.

Later Tuesday, Hulshof campaign spokesman Scott Baker clarified that the total cost of the proposal is estimated at $590 million annually. Most of the rest would be paid for by redirecting money that currently goes to hospitals to offset part of their costs of treating the uninsured, he said.

Families of four earning up $50,000 annually could qualify for a subsidized health care plan, Hulshof said, but would be expected to pay up to 5 percent of their income. Those consumer payments are projected to cover for about $35 million of the total $590 million cost, Baker said.

Anyone — rich or poor, healthy or sick — could buy health insurance through the state-overseen clearinghouse, Hulshof said.

New figures released Tuesday from the U.S. Census Bureau estimate that 729,000 Missourians — or 12.6 percent of the population — lacked health insurance in 2007. That’s down 43,000 people from the previous year but still up from the 670,00 who lacked insurance in 2004, before the Medicaid cuts were made.

Democratic gubernatorial nominee Jay Nixon has made health care a top campaign issue, pledging to reverse the 2005 cuts by Republican Gov. Matt Blunt and the GOP-led Legislature that eliminated or reduced benefits to hundreds of thousands of Medicaid recipients.

In July, Nixon proposed to spend $265 million annually in state funds and $431 million in federal money to restore the Medicaid cuts and to allow middle-class families to buy into a government-run health care plan for their children.

Nixon spokesman Oren Shur criticized Hulshof’s plan for leaving the Medicaid cuts in place and thus missing out on the additional federal money.

“The congressman’s proposal will not significantly reduce the number of uninsured Missourians, and therefore, it is unlikely to significantly drive down the cost of insurance for Missouri families,” Shur said.

Hulshof, a congressman from Missouri’s 9th District, has joined Blunt and many Republican state lawmakers by generally backing the 2005 Medicaid cuts as a budgetary necessity.

On Tuesday, Hulshof repeatedly denounced Nixon’s proposal as a return to a costly and poorly managed Medicaid system.

“Hitting the rewind button to go back to the 20th century is not the answer,” Hulshof said.

Hulshof proclaimed health care a priority last winter when he entered the race after Blunt chose not to seek re-election. But Hulshof waited to outline any health care specifics until several weeks after his Aug. 5 primary victory over Republican Treasurer Sarah Steelman. He said he was consulting with health care professionals while carefully crafting his plan.

Among those Hulshof consulted was the Missouri Hospital Association, which was instrumental in shaping Blunt’s unsuccessful Insure Missouri plan to expand government-subsidized coverage to low-income workers. That plan also would have redirected a portion of the money now paid to hospitals for treating the uninsured.

Blunt’s plan died this year in the House, where some Republicans were uneasy about increasing the government’s role in health care.

Hospital association spokesman Dave Dillon said the group has endorsed neither Hulshof’s nor Nixon’s plan, but “we endorse the discussion about expanding health care from a larger perspective.”

Brent Butler, the government affairs director for the Missouri Insurance Coalition, said the group has not seen the details of Hulshof’s plan and has no position on it.

“As long as the insurance buying market at this time is not affected, or the companies are not adversely affected, nobody would be against trying to get people more coverage,” he said.

Hulshof said his plan is different from Insure Missouri and from plans offered in other states as a means of covering the uninsured.

One key, he said, would be a requirement that insurers participating in HealthMAX could not deny coverage to people because of existing health conditions. Whereas that might normally make insurers reluctant to join the program, Hulshof said he hopes to spread their risk by creating a large pool of people.

Individuals would purchase their own health insurance plan by picking among various options. Businesses also could make contributions to the plan on behalf of employees.