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Health, Science, Environment

Hospitals to work with state in an effort to expand health care

This article first appeared in the St. Louis Beacon, March 9, 2009 - With his key health-care initiative stalled in the Missouri Legislature, Gov. Jay Nixon is turning to other approaches to expanding health insurance to the needy and unemployed.

On Monday, he appeared in several cities across the state to announce what he says is a landmark agreement that will bring health care to nearly 35,000 parents at no increased cost to the public.

Under the plan, the Missouri Hospital Association will contribute $52.5 million yearly to provide health care to eligible parents in the state. The money will come from funds that Hospital Association members receive for uncompensated care for uninsured patients. The state would then take the association's contributions to draw down roughly $93 million in federal matching funds for health care.

The program isn't new. The state and hospitals have used it over the years to buy more Medicaid coverage for needy Missourians. The difference is that the Nixon proposal would ease the income guidelines for eligibility. Ordinarily, Missouri parents are eligible for state coverage only if they earn no more than 20 percent of the federal poverty level. For a family of four, that translates into about $4,410 a year.

Under Nixon's new approach, Missouri parents would qualify if the family income is up to 50 percent of the poverty level - or roughly $11,025 for a family of four.

With hospitals on board, the only potential stumbling block is the General Assembly. It wouldn't have to spend any tax dollars, as Nixon notes, but would have to raise the income guidelines to allow more parents to qualify.

Nixon's first stop to announce the proposal was at the People's Health Centers, 5701 Delmar Boulevard. He said he was focusing on health care for parents because they need to be healthy enough to work and care for their children.

"Too many parents are going without the medical care they need," he said, "or they're turning to emergency rooms instead of a traditional doctor's office."

That choice, he says, means "families with health insurance are picking up this tab with higher premiums and co-pays" to cover the cost of needy patients who turn to emergency rooms. Nixon also appealed to state lawmakers to join him to allow the state to generate the additional $145 million -- $52.5 million from the Hospital Association and $93 million in federal matching money -- to provide health care for an additional 34,800 parents in Missouri.

"Let me repeat myself for the third time," he said. "The state doesn't have to appropriate a penny for this program. This is a good first step to providing health insurance in the state."

The governor previously proposed to use some of the state's federal stimulus dollars to expand coverage for more adults and children, including many low income residents who would not have had to pay premiums. But the House Budget Committee, headed by Rep. Allen Icet, R-Wildwood, voted earlier this month to put that proposal on hold. Some lawmakers suggested that people should be required to pay something for the care, even though studies have shown that even modest premiums have discouraged many families from seeking care. These families in turn seek care in emergency rooms.

Marc Smith, head of the Missouri Hospital Association, made that point at the press conference. He called the Nixon proposal "an opportunity we can't afford to miss. Everyday we see the consequences of people who have no health insurance. They are either getting it here (at People's) or in the hospital emergency room, which is an expensive place" for routine health care.

Later today, the governor was to make similar announcements in Cape Girardeau and Springfield. On Tuesday, he was to take his health care message to Columbia and Kansas City.

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