Creating State Healthcare Reform

by Brian L. Baker

It should be easier for many of the estimated 700,000 uninsured Missourians to afford health insurance and have a better idea of what health care goods and services cost under legislation currently in the Missouri House.

Building upon our tax equity and portability successes from last year, we are now in a position to continue making market-based reforms to improve access to affordable coverage for those who are unable to be medically underwritten and to low-income individuals. It is also time for Missourians to be given the information necessary to be informed consumers and not just participants in their health care. We have a right to know the cost and quality of health care before those services are provided. As I leave the Missouri House, I am supporting legislation that takes steps to bring real reform and looks to free-market principles to help the consumer.

The first part of reform begins with “Transparency.” I co-sponsored HB2394 relating to price and quality transparency in healthcare. I believe that people have the right to know what health care costs and have some idea of the quality of that care before the care is provided. All of us, at one time or another has driven across town to save a penny or two per gallon of gas or spent time clipping coupons, but we don’t always think about the price of health care or services. Many times we never look beyond our co-pays. As consumers of health care we act irrationally, especially when it is paid for by a third party or employer. This is largely due to the lack of price and quality information available to consumers.

The proposed plan ensures that people have the right to request an estimate of the costs of their in non-emergency situations. It is not that we don’t care about what something costs or how good our doctor is, but simply that we have never been given the opportunity to find out. Let’s face it, we have a health care system that is price blind and quality silent, patients demand and deserve better than that.

I am also a co-sponsor for HB2413 relating to access and affordability of health coverage through the MHIP and the Insure Missouri program last week. This plan uses the Missouri Health Insurance Pool to help the medically uninsurable. It will provide affordable health insurance through the high risk pool known as the Missouri Health Insurance Pool (MHIP). The MHIP serves individuals who have medical conditions that insurers won’t provide coverage to in the individual health insurance market. These individuals typically do not qualify for public assistance and do not have an employer health insurance plan available to them. It is estimated that one to two percent of Missouri’s population is considered medically uninsurable.

Currently, individuals qualifying for the high risk pool pay 150% of the standard market rate for coverage. HB2413 would lower that rate to the standard market rate for lower income enrollees and cap the rate at 125% of the standard market rate for higher income enrollees. The plan also authorizes the MHIP to create a low-income premium subsidy program to assist low-income enrollees.

Small businesses can benefit from this legislation. Small businesses find the cost of providing employees with employer-sponsored health insurance to be excessively prohibitive, especially when an employee or dependent has a significant health problem. HB2413 would create a pilot program to allow insurers to transfer the high risks from the small group to the MHIP through a risk transfer product with the intent to stabilize rates for the small group. It is estimated that half of Missouri’s uninsured population work for small businesses.

HB2413 rewrites the Governor’s Insure Missouri plan. This proposal will provide premium assistance to low-income Missourians allowing them to purchase individual health insurance policies. The program is intended to assist at least 71,000 low-income, working adults.

Each Insure Missouri policy holder will be required to make a monthly contribution, based upon income, to a separate account to pay for deductibles and co-pays. Failure to make the monthly contribution will cause the individual to be removed from the program. This creates accountability and sustainability.

The Insure Missouri plan allows those qualified individuals to purchase an individual health insurance policy while promoting personal responsibility and ownership of their health, leveraging private market innovations, focusing on prevention and wellness, and using existing revenues to pay for the plan, thus eliminating the need to raise taxes.