Updated April 20, 2009

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Health Care Insurance for the Poor and Their Children

The members of the Missouri Union Presbytery surveyed this past year indicated that health insurance for the poor and their children would be the most critical issue for the Church and Society Mission Team to track during 2009.

Background:

In 2007, The Commonwealth Fund produced a state scorecard that examined health system performance across five dimensions:

              1. Access;

              2. Quality;

              3. Avoidable Hospital Use and Costs;

              4. Equity; and

              5. Healthy Lives.

This scoring system offered a framework for states to “gauge efforts to ensure affordable access to high-quality, efficient, and equitable care.”  Overall, Missouri ranked 37th among states across all five dimensions. This ranking was, however, published before the newest data was released that showed a 14 percent increase in Missouri’s uninsured population.

The percentage of uninsured state residents played a major role in determining the state ranking on the access dimension.  But, from 2006 to 2007, Missouri’s uninsured population increased from 668,000 to 772,000 people.  This is an increase of 14 percent in one year, with the percentage of uninsured Missourians increasing from 11.7 to 13.3 percent.  

The growth in the uninsured can be tied to both the decrease in Missouri’s Medicaid coverage in 2005 and the decrease in the number of Missourians with employer-sponsored health coverage.  Nearly 150,000 of those uninsured were children.

The number of uninsured Missourians contributes to two significant problems in our health care system.  First, people tend to delay treatments when they do not have insurance.  This can lead to more serious illness when they do seek treatment and more costly procedures to treat the illness.  When uninsured do seek treatment, it is often at the very expensive emergency room and when the person is released they often have no way to pay the ER bill.  The hospitals and physicians that provide these services cannot collect on these bills and must treat un-paid bills as an overhead cost that they spread across charges to all the other patients who do pay for their hospital care.  This is process is called cost shifting and increases medical cost to all the insured Missourians.

The problem of uninsured adults is a multifaceted problem involving several financial and health issues affecting the priorities and choices of the individual. Health care coverage for children is affected by these same issues, but the final choice is not made by the child.  This problem will likely be addressed by actions which focus on small parts of the total problem rather than a single solution, such as universal health care coverage.

Senate Bill 306  Dempsey  (R 23)  “SHOW-ME HEALTH COVERAGE PLAN”

The Senate Substitute for the Senate Committee Substitute for Senate Bill 306 was approved by the Senate on April 17, 2009.  The proposal provides for a very complicated, phased-in health insurance program for poor working parents.  The new insurance program is to be administered and paid for by the state, but marketed through private insurance companies and agents.  The proposal allows insurance companies to receive as compensation up to 12% of the total program costs.

INOME ELIGIBILITY LEVELS

All increased eligibility in this proposal is conditioned upon the state funds being specifically approved to pay for the cost of newly-eligible working custodial parents.  If the funds are available, the proposal would expand eligibility in annual steps which might begin in 2010 if the Department of Social Services can get the required approval from the federal Department of Health and Human Services.  The proposed eligibility expansions are as follows:

DEDUCTIBLE / CO-PAY REQUIRED

The proposal requires that all participants have a Health Savings Account which will be used to hold and pay the deductible / co-pays required by the proposal.  Required co-pays are adjusted according to the participant’s income as described in the table below.

Group 1: Custodial Parents up to 100% - flat amount

Group 2: Non-Custodial Adults-1% of Annual Income greater than 50% FPL

Group 3: Adults Between 100% and 125% FPL-2% of Annual Income @ 100%

Group 4: Adults Between 125% and 150% FPL-3% of Annual Income @ 125%

Group 5: Adults Between 150% and 200% FPL-4% of Annual Income @ 150%

Group 6: Adults Between 200% and 225% FPL-5% of Annual Income @ 200%

Participants will be terminated if the required co-pay amount is not deposited in the Health Savings Account with in 60 days of when required and when a participant is terminated they must wait six months to re-apply to the program. Custodial parents in the lowest income bracket (under 50% of FPL) who pay the smallest deductible are limited to 3 years total participation.

FUNDING

The proposal anticipates using federal Medicaid funds and provides that the program will terminate if federal funds are not appropriated or approved for reimbursement by the Department of Health and Human Services.  Also, the proposal requires hospitals to provide the program, through the FRA program, funding from funds provided them to cover disproportionate share of charity care costs.  Together, the plan is to combine funds from the participants, hospital funds and state general revenue funds to match the federal Medicaid funds which cover about 63% of the total costs.

IN OUR OPINION

If approved and funded, this proposal would make progress over the next four to eight years in providing health insurance to low income working parents in Missouri. A large majority of the Presbyterians in the Missouri Union Presbytery believe that it is the top priority to provide health care coverage to the working poor families in Missouri, and therefore, we believe they would support this proposal.

As it is currently constructed, this proposal is very complicated, requiring:

• the state agency to provide the program through private firms;
• the participants to create and maintain a health savings account;
• the participant, their employer or the state make payments into a health savings account from;
• in varying proportions and at times depending on their earnings which will be at or near poverty;
• participants must have a primary care physician know as “health home.”

Both the costs and the administrative difficulties will make participation in this program difficult for many of the potential participants. The administrative requirements will make this a more costly program than the existing Medicaid program.

You can learn more about SB 306 by clicking on the following link:

SB 306

Budget Action:

Rather than passing legislation to implement new or expanded health care initiatives in 2009, it is also possible that the state legislature may expand coverage or making health insurance more affordable for the poor will come as a result of appropriations actions in Missouri’s General Assembly.  In the appropriations for the Department of Social Services, Governor Nixon proposed an increase in expenditures for the State Children’s Health Insurance Program (SCHIP), a reduction the premiums poor working families have to pay to buy coverage for their children and to increase eligibility of working poor parents from 22% of poverty to 50% of poverty.  Together, these proposals would have expanded health insurance coverage to an additional 27,000 children and 35,000 poor working adults.  Because this was done as part of the existing Medicaid program, and involves a special hospital supported program, cost would be shared as follows:

The Governor’s proposal seems to provide the maximum benefit for the least investment of state funds. When the House of Representatives approved its version of the FY 10 state budget in March 2009, they did not include funds to support this health care proposal.

The Senate Appropriations Committee has begun considering the FY ’10 budget and will consider whether or not to include the Governor’s proposal.

In our opinion, it should be a priority goal for our state to reduce the number of uninsured children and families in Missouri.  The Senate should restore the Governor’s proposed expansion of the Medicaid program. Any one who agrees could call their state Senator and express support for restoring these funds. 

Other Legislative Actions:

As of March 26, 2009 all of the legislative proposals identified below as possibly helpful toward health care, are effectively dead in the Committee where they were assigned. If legislation has not been approved by the initial Committee it was assigned to by the mid point of the annual legislative session, it is usually dead for the year.

HB 143 - Hughes, Leonard (D 42)  

Establishes the Missouri Universal Health Insurance Act to provide comprehensive and necessary health care services for Missouri residents.

HB 123 –  Rep. Sam Komo (D 90)  

Allows certain small employers to obtain medical coverage through the Missouri Consolidated Health Care Plan.

HB 293  – Rep. Bob Nance (R 36)

Requires the Department of Social Services to provide all public school districts information on the state's health insurance program for uninsured children to be distributed at school enrollment.

SB 103 – Sen. Tim Green (D13)

Creates an income tax deduction for small businesses and farmers that provide health insurance coverage for employees

SB 120  – Sen. Joan Bray (D 24)

Allows small employers to obtain medical coverage through the Missouri Consolidated Health Care Plan.

In order to read further about this legislation that has been introduced, please visit the General Assembly’s website click on the link below:

www.moga.mo.gov

We welcome your thoughts and feedback. Please use the following email address to let us know opinion: C&S Mission Team