JEFFERSON CITY - Columbia Rep. Chuck Graham has had his own dealings with managed care and not all of them have been good.
The freshman Democrat said that when he tried to get a replacement for his wheelchair seat cushion, his HMO, United Health Care, took over two months to replace the $400 cushion.
Ironically, Graham got his cushion on his first day as a state representative and one week before the unveiling of the "Wall of Pain" -- a list of health horror stories from advocates pushing a complete overhaul of the health care system.
Graham said he first tried to get a new Roho seat cushion around the first of November. The cushion is needed, he says, to prevent pressure sores. His initial attempts to get a replacement were unsuccessful.
"First I got a letter from my health care provider saying that they were considering it," he said.
"If I had gotten a pressure sore and I had to have surgery to repair that, I would have been on my stomach for six weeks," he said. "That would have cost in the tens of thousands of dollars."
His recent example, says Graham, shows that HMOs and managed care can sometimes increase the costs of health care inadvertently.
Also, there is the other costs of missing work, and lack of productivity and effectiveness, he said.
Graham said HMOs have to make decisions about people's health and not always about the bottom line.
He said he supported and signed onto fellow Columbia Rep. Tim Harlan's bill to reform the managed care industry as a cosponsor.
One of the main issues in that bill for Graham is the elimination gag clauses.
"There should be absolute 100 percent free speech between a patient and a doctor," he said. "The Hippocratic Oath is a bond between patient and doctor. There is a trust there."
Rep. Vicky Riback Wilson, D-Columbia, also signed onto Harlan's bill as a co-sponsor. She says the bill is the first step towards looking at other issues such as pre-existing conditions.
Graham's story and Harlan's bill come on the same day as the unveiling of the "Wall of Pain." The wall, sponsored by Mid-Missourians for Universal Single Payer Health Care and other advocacy groups, highlights instances where people couldn't afford health insurance or weren't allowed to get it because of pre-existing conditions.
A single payer system operates under the principle that everyone is guaranteed coverage and the system would finanaced through public funds but administered through a private company.
Rep. Mary Bland, D-Kansas City, is sponsoring a bill that calls for universal coverage in Missouri. While Bland and other sponsors don't think the bill will pass this year, they say that each time they introduce the bill, more and more people sign onto it.
Bland, who is also on the managed care committee that unvieled its managed care reform package on Wednesday, has also pushed for protection for community providers in rural and urban areas, whom she says have a unique understanding about their patients.