Missouri Health Care Legislative Update

The Missouri legislative session was dominated this year by the budget and Congressional redistricting. Despite those challenges, a few health care related bills found their way to the Governor’s desk.

Fortunately, one of the bills that made it across the finish line was House Bill 412, which contained reauthorizing language for the MORx program. This critical program was set to expire without legislative intervention. I was the Senate sponsor of the language, which provides “donut hole” or gap coverage for prescription costs not covered by Medicare Part D. Over 200,000 dual eligible (Medicare and Medicaid) Missourians use this vital program and without it, many of Missouri’s most vulnerable citizens would be faced with the loss of lifesaving drugs.

Senate Bill 62 included two transparency provisions. The first allows policy holders to obtain the true cost of their own insurance (including employer contributions), and the second limits the cost of collecting copies of medical records from health care providers. The main provision of the bill however, was the extension of the FRA tax to 2015. This provision, advocated by hospitals, is a self-tax which funds Medicaid and hospital reimbursements by drawing federal matching dollars. The tax was set to expire this year and some experts forecasted that without the extension, Missouri would simply opt out
of offering many Medicaid services.

House Bill 270 was limited to participants under the Missouri Consolidated Health Care Plan (mainly state employees). It allows Medicare eligible participants under MCHCP to get pricing below the standard non-high deductible when their MCHCP coverage is not primary. The coverage given must be substantially similar to that offered to non-Medicare eligible participants. Current law requires the same coverage benefits, but without the pricing limitation.

State implementation of federal health care reform was understandably a hot topic in the legislature this year. House Bill 423 would allow Missouri to join other states in a health care compact. According to the bill language, compact members could then supersede federal health care law. The bill also says that member states are entitled to whatever federal funding they would have received before they superseded federal law. It is unclear whether this bill actually accomplishes anything however, because it only goes into effect upon passage by two member states, and the approval of the United States

Just as important as what passed, were the bills that didn’t pass. The most notable was a health insurance exchange bill (House Bill 609). The bill was proposed in response to the federal Affordable Care Act. In brief, the bill would have allowed the state to opt out of the federal health insurance exchange and create its own exchange. As the legislative session progressed, it became apparent that opponents of federal health care reform in general were going to block the idea of a state exchange, because they believe the entire federal law will eventually be thrown out by a federal court, making state implementation of federal reforms a moot point.

Health insurance exchanges are new entities designed to create a more organized and competitive market for health insurance by offering a choice of plans and by establishing common rules regarding pricing. Proponents of HB609 argue that it makes more sense for Missouri to create its own exchange, rather than waiting for the federal government to create one. The issue is complex and politically charged and it is guaranteed to return during the 2012 legislative session.


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