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Bill would insure children of Missouri's working poor

January 29, 1998
By: Brent P. Johnson
State Capital Bureau

JEFFERSON CITY--Medicaid benefits would reach thousands more children living in Missouri without health care insurance under a proposed Senate bill.

Statewide, an estimated 175,000 children in Missouri lack such insurance, according to Gov. Mel Carnahan. The situation can deprive them of access to preventive care and can put their families at economic risk should a serious condition arise.

Legislation sponsored by Sen. Edward Quick, D-Liberty, and supported by Carnahan would extend Medicaid coverage to them through federal funds now available.

Last year, Congress passed the State Children's Health Insurance Program as part of the Balanced Budget Act, directing $4.275 billion to low-income children lacking health insurance. Missouri stands to receive $51.6 million and has requested maximum flexibility from the Health Care Financing Administration to use it.

Greg Vadner, director of medical services at the Missouri Department of Social Services, advocates extending Medicaid coverage to families living at up to 300 percent of the poverty level. Not reaching that level, he said, fails to utilize the entire federal allocation and only sends the remainder to another state.

Currently, Vadner said, the state covers children to age 1 at 185 percent of the poverty level; children from ages 1 to 6 at 133 percent of the poverty level; and children above 6 at the poverty level or below.

In 1996, the poverty level stood at $12,629 for a family of three, according to the Census Bureau. Three hundred percent of that level would extend benefits to those at income levels up to $37,887.

"That's a pretty decent income," said Sen. Morris Westfall, R-Halfway. He is concerned that even by extending coverage to 200 percent of the poverty level there aren't enough children without health insurance to receive it. "At what point is it the government's responsibility? The major debate's going to be at what level to kick it in," Westfall said.

Last year, Missouri failed to pass similar legislation pushed by the governor that fell prey to a Republican-led filibuster in the Senate on the last day of the session. As designed then, a not-for-profit organization would have financed coverage for uninsured children using grant money and general revenue funds.

Under the current proposal, Missouri would be required to match the federal allocation with $20 million of its own funds, Vadner said.

"Many people saw it as socialized medicine in competition with private insurance companies," Quick said. "If they chose to be against it, they could find reasons to be against it."

This year's bill, however, seeks financing from an existing federal program recently expanded--Medicaid--instead of an independently established program. "We chose Medicaid because it's part of the current system; it's efficient, cost-effective, most likely to be acceptable, and it's historically focused on children," Vadner told the Senate Public Health and Welfare Committee Monday.

Coleen Kivlahan, a former director of the Missouri Department of Health and now a practicing physician in Boone County, voiced concern about those who receive neither public nor employer assistance for health insurance. "It makes no sense not to provide (for) children whose parents make too much for Medicaid but too little for private insurance."

Quick expects resistance to passing the bill again this year. "There'll be a battle before it's over. But with an election year, I hope we won't argue just for the sake of arguing."