Republicans seek to require all Missourians to have health insurance

JEFFERSON CITY - Missouri's top Republican senators are pushing legislation to require all uninsured Missourians to have health care coverage starting in 2009. But the bill's sponsor says the plan is not tantamount to universal health care because private companies would offer insurance through the state.

Modeled after a similar plan that was approved in Massachusetts last year, the bill was introduced to a Missouri Senate health care committee Tuesday by Sen. John Loudon, R-St. Louis County.

The push to require health coverage for the uninsured is a top issue in many state legislatures this year, as lawmakers seek to reduce the estimated 46 million Americans without health insurance.

"I just think we have a tremendous opportunity to make a huge difference in the lives of hundreds of thousands of Missourians, and additionally, make them healthier," Loudon said after the committee meeting.

A number of Republicans have joined Loudon in supporting the bill, including Senate Majority Leader Charlie Shields, R-St. Joseph, and Senate President Pro Tem Mike Gibbons, R-St. Louis County.

But insurance companies are opposed to the plan, saying it is too drastic in changing the way health coverage is delivered.

"This would completely unravel the current business model," David Smith, an attorney for insurer Blue Cross/Blue Shield, told the committee. Smith urged lawmakers to instead focus on changing how people use medical care to reduce the burden that the uninsured place on the health care system.

Under the proposal, all uninsured adults in Missouri would have to prove to the state that they have the ability to pay for medical care for themselves and their dependents. Those who do not already have coverage from their employer, Medicare or Medicaid, would be encouraged to purchase a private health insurance plan offered through a state-run body. Although purchasing a plan through the state would not be mandatory, only people who have $10,000 on hand would be able to opt out. If the bill passes, Missourians would be able to deduct all of what they spend on health care premiums from their state income taxes.

Private insurers would work with the state in creating insurance plans that would be subject to approval by a new state board, whose members would be appointed by the governor. Companies with 25 or fewer employees would be required to participate in the state-run insurance programs.

The bill currently does not provide any assistance for low-income Missourians to purchase coverage, but Loudon said he was working on adding a low-income subsidy to the bill's language. The amount of the subsidy is unknown.

David Smith of Blue Cross/Blue Shield was skeptical that the plan would work and urged legislators to wait and see if Massachusetts' program was successful. He said 200,000 people in Massachusetts were facing higher health care insurance costs because of that state's approval of a plan similar to the one proposed in Missouri.

"We are the Show-Me state," Smith told the committee. "Let's see it work somewhere (else)."