State senators get a thorough briefing on national health care, but don’t get the answer they crave most: how much will an overhaul cost Missouri.

The National Conference of State Legislature’s Joy Johnson Wilson, speaking via telephone, tells senators the two versions of health care legislation in Congress vary greatly. The United States House in Washington, D. C. approved its version first. The Senate wrangled over several versions before settling on one that contains significant differences, most prominently the omission of a public health insurance option.

Johnson notes that the Senate version wouldn’t have passed at all without the famous Nebraska compromise.

“In the case of Nebraska, Sen. (Ben) Nelson was the 60th vote, so it goes.” Johnson says, referring to the need in the United States Senate for 60 votes to prevent any filibuster.

That point is a bit touchy with Missouri lawmakers, because Sen. Nelson, a Democrat, got Nebraska a sweetheart deal, shielding it from any increased costs from the legislation. In the Senate bill, Nebraska gets 100% reimbursement from the federal government to offset an increase in the cost of Medicaid.

“We understand that now Sen. Nelson is working very hard to try to make sure that every state gets a good deal like Nebraska did,” Johnson said to laughter from the panel of senators. “And we all hope he’s successful.”

Special financial incentives have also been included for Louisiana, Massachusetts and Vermont.

Medicaid would expand under both versions. The House bill would establish a national minimum eligibility level of 150% of the federal poverty rate. The Senate sets the minimum threshold at 133%. New categories would be added, including parents as well as single, childless adults who aren’t disabled. The House version expands coverage to newborns. The Senate version includes former foster care children.

A big difference between the two bills, according to Wilson, is the definition of eligibility. The Senate version will not provide states extra reimbursement for enrolling individuals in Medicaid who were eligible, but not enrolled. The House version will provide federal reimbursement for any new enrollee.

State and local governments would be viewed as large employers under the legislation, required to comply with the business mandates in the bill. The House would require the states to contribute 72% of the cost of employee premiums and 65% to the cost of family coverage. The House bill also holds the states responsible for local compliance with the law. The Senate bill would go so far as to impose a tax on states that fail to comply with the legislation’s provisions.

Wilson says too much is in play to give lawmakers an answer about how much a bill might cost Missouri, a point worrisome to Senate President Charlie Shields (R-St. Joseph) who wants Congress to slow down.

“You know, I wish that could stop and I urge people to take action on that and we’re going to talk about in the Senate and the House passing resolutions urging our members of Congress to slow down,” “but, at this point, I have no indication that’s actually going to happen.”

Shields estimates any bill coming out of Washington will cost Missouri at least $250 million.


Brent Martin repors [1:20]