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It's Back!

December 12, 1995
By: ELISA CROUCH
State Capital Bureau

JEFFERSON CITY - Like the annual winter flu, the issue of universal health care will be back for another go-around during the 1996 legislative session.

For the second year in a row, Rep. Mary Bland, D-Kansas City, will try to convince the General Assembly that a single-payer, state-run health care plan is the best prescription for the state. Legislators have proposed similar bills since 1990.

"Health care in this state is in a state of crisis," Bland said, naming health maintenance organizations and outlandish insurance rates as two factors hurting health care.

According to the state Insurance Department, 630,000 Missourians are without health insurance. Sam Eveland, a spokesman for the department, said that 75 to 80 percent of the uninsured are working-class poor, who most likely cannot afford insurance.

But like the single-payer and universal health care proposals have in the past, this one's encountering stiff opposition from Republicans.

Rep. Charlie Shields, R-St. Joseph, said a universal health care system wouldn't work in Missouri. Shields voted against the plan last year and said he would vote against it again if the proposal makes it to the House floor. "I'm fairly convinced the vast majority of Missourians don't want a single payer plan in the state," he said.

In addition to public opinion, Shields said that a single-payer plan would create more problems than it would cure. One is that people with expensive illnesses would flock to Missouri.

A second reason, Shields said, is the cost. Under the plan, citizens and companies would pay through income and payroll taxes. Last year, the plan's fiscal estimate was more than $129 million.

"To put that kind of cost on the state and say your going to pay for it with a payroll tax creates problems," Shields said.

Bland said that the effect the plan would have on small businesses is one detail the interim committee was focusing on during the fall. She said last year's bill will be modified to reduce the burden on small businesses in paying for the cost.

This fall, an interim House committee examined the issue during public hearings and meetings held throughout the state.

"We came up on stories with people not being able to get insurance with preexistion conditions," said Rep. Rita Days, D-St. Louis County, a member of the committee. She also said that health mergers across the state have left citizens without any kind of security.

C.C. Swarins, executive vice president of the Missouri State Medical Association, said that his organization opposes the legislation. "We don't think we're ready to have a one-payer program like Canada has," he said.

Swarins said that such a plan would scare off doctors in the state if approved.

"It would set up a system where doctors would become employees of the state," he said. "Many doctors don't want to be employees of the state."

Not all Republicans oppose universal health care. One GOP member on the House task force says he endorses the single-payer system.

Rep. Jim Murphy, R-St. Louis County and member of the interim committee, said that heath care is a basic right and the state should ensure that citizens receive it.

"If you have a serious illness and you go to a hospital, the question is your money or your life if you don't have insurance," Murphy said.

Under the proposed plan, all Missourians would be required to give up their insurance plans and use the single-payer system. Rep. Carson Ross, R-Kansas City and committee member, said he opposes the plan for this reason.

"It would take away freedom of choice," he said.

But Bland said that her plan would do just the opposite. Although all Missourians would be required to use the plan, Bland said the plan would eliminate the stronghold HMOs and some insurance plans enjoy.

"It also provides choice for a person to choose their own doctor and their own hospital," she said. "Overall it will bring a competitive level to doctors again."

But despite their work, members of the interim committee said that the single-payer plan probably won't catch on this year.

"I think it will take several years," Days said. "We're going to have to give managed care an opportunity to either fail or be successful."

Bland agreed. "Although support is really growing, there are too many legislators who don't agree."