The bill would provide insurance coverage to 20,000 Missourians who cannot get insurance because of pre-existing conditions and uses federal money given to hospitals for treating uninsured patients in the emergency room.
The House version of the bill has been an overhaul of the Senate version, which used the same funding mechanism to give insurance to working parents in poverty but who make too much to qualify for Medicaid.
"The difference is this -- their plan was based on income," said House bill handler Kevin Wilson, R-Neosho. "Our plan is based on health need. And I think that's the biggest difference."
The bill did lose some of its Republican support when an amendment was introduced that the bill floor handler said would reduce transparency. Rep. Doug Ervin, R-Holt, said that consumers need more information about the cost and quality of services provided by health care providers such as hospitals.
"They fundamentally oppose the comparison of one physician to another physician or one facility to another facility, whether it's in the form of this bill or another bill," Ervin said. "Right now in this building, the hospital association owns the place."
But Sen. Tom Dempsey, D-St. Charles County, said that focusing on the Hospital Association and transparency was taking the focus away from the point of the bill.
"Both representatives (Doug Ervin and Rob Schaaf) had been talking about a paramount interest was covering the uninsurables," Dempsey said. "Yet when they designed a bill that covered the uninsurables, when an unrelated subject, the transparency part, was amended, they were no longer supportive of a bill that provided coverage for the uninsurables. So really what is their primary concern? Is it uninsurables or is it strong transparency language?"
Dempsey also said that the roll-call vote on the amendment showed that transparency wasn't a stick point for a majority of the House.
Another amendment that generated strong debate would allow for drug testing of Temporary Assistance for Needy Family recipients, provided that there was suspicion the recipient was using drugs. If the recipient were to test positive, the amount of welfare given to the family would be reduced by $58 per month.
Amendment sponsor Rep. Ellen Brandom, R-Sikeston, has already had identical legislation pass the House but said she put it in the health care bill as a backup plan in case the bill didn't fare well in the Senate.
Rep. Jeff Roorda, D-Barnhart, said he was opposed to the amendment and said taking away money from the drug-abusing parent was effectively punishing the child for the sins of the father. Roorda encouraged his colleagues to vote for the amendment in hopes of bringing down the whole bill.
"I really hope this amendment passes. It makes a bad bill even worse, and also makes it unconstitutional," said Roorda.
Rep. Don Calloway, D-St. Louis County, a lawyer, said the amendment was unconstitutional because while it did further a legitimate state interest, it was not narrowly tailored.
"The means are not rationally tailored to achieve that state interest because a specific group of people, Temporary Assistance to Needy Family recipients are improperly, impermissibly, and illegally singled out. How do I know that they are singled out? Because we're not including drug testing provisions for people who receive state salaries." Calloway then introduced an amendment to the amendment that would deny members of the Missouri General Assembly their benefits if they tested positive for drugs.
Dempsey said that while he agrees with Brandom on a philosophical level, adding a controversial amendment like that could make it harder to get the bill passed in the final week of session.