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Group Supports, Yet Has Questions About Insure Missouri

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A group often critical of the Blunt Administration has praise for the governor’s plan to expand health care coverage, at least for the concept.

The Missouri Budget Project still wants to hear details. Executive Director Amy Blouin says Governor Blunt’s Insure Missouri could be very beneficial for Missouri and could help some Missourians who lost Medicaid coverage in 2005 regain health care. Yet Blouin wants some details, especially about how it is to be funded.

Blouin says states which have built upon a Medicaid structure have had some success in programs similar to Insure Missouri. She says states which have chosen to fund the program by providing incentives so that businesses offer health coverage to employees hasn’t worked. Blouin says it appears the Blunt Administration has a good funding structure, but she wants to see more details to determine if it is truly "fiscally sustainable".

Another big concern of the Missouri Budget Project is rural Missouri. Blouin notes the plan relies on HMO coverage, which doesn’t extend very far in rural Missouri. Blouin says that while the St. Louis and Kansas City areas have thorough HMO coverage, that coverage doesn’t extend very far into rural Missouri. 

Download/listen Brent Martin reports (:60 MP3)

Insurance Department Fines Chesterfield HMO $100,000 For Violating Prompt Pay Law

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The State Insurance Department has levied its biggest fine ever – more than $100,000 – against an HMO based in Chesterfield. Insurance Director Scott Lakin says Mercy Health Plan violated the state’s prompt pay law by failing to acknowledge receipt of about 20 percent of the claims filed with it. The law requires HMOs to acknowledge claims within ten days. Lakin says Mercy has paid its fine promptly, without objection. He adds several more companies are being examined.

Lawmakers Wrestle with HMO Changes

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A proposal to end the need for Missourians to change doctors whenever they change HMOs is under debate in the state Senate. The Senate’s only doctor says cancer patients, pregnant women — and anybody else — should be able to keep their doctor even if their insurance company changes. Senator Marvin Singleton of Seneca favors the “any willing provider” concept, which says any doctor who qualifies to submit insurance claims should be allowed to submit them to whatever HMO insures his patient. Singleton says the priorities are wrong now. Some Senators worry that Singleton’s proposal will drive up health carecosts, especially to large companies or even to stategovernment, which provides coverage to its employees. The Senate will spend more time on his proposal later.

HMO’s Ordered To Stop Dragging Their Feet

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Health Maintenance Organizations are being ordered by the Legislature to stop delaying payment of consumers’ bills. A prompt pay bill has been sent to Governor Holden for his signature – a bill requiring payment of claims to start within fifteen days after they are filed – unless the company needs more information. In time, penalties could kick-in for non-compliance. Those supporting the legislation say insurance companies make a lot of money by delaying payments.

Women’s health care focus of bill

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Legislation forcing insurance companies to loosen restrictions on common women’s medical care has been filed in both the House and Senate. Representative Joan Barry of St. Louis sponsors the bill that mandates direct access to an OB/GYN. The bill also mandates notification of cancer screenings, provision of bone density testing for elderly women and contraceptive coverage. Barry acknowledges the health insurance lobby will likely resist the legislation and contraceptive coverage might also spark protests among some pro-life lawmakers.

HMO membership drops

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We’ve learned that more and more Missouri workers have healthcare coverage these days. And many of those newly-insured are not covered by health maintenance organizations. They are being covered by preferred provider organizations. Randy McConnell of the Missouri Department of Insurance says there’s a willingness on the part of both employers and employees to pay the added costs associated with PPO’s, so they can avoid the limitations of HMO’s. HMO membership dropped by 42,000 last year. It comes at a time when the health insurance groups increased premiums by 13%.

Ashcroft explains new HMO stance

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Senator John Ashcroft denies his support of a recent compromise on health care reform is an “election-year conversion.” Ashcroft has voted against such measures in the past. He now supports a revised version of the Norwood-Dingell bill that has been debated in the presidential campaign. He says the new bill would allow doctors to make the decisions, not government or HMO bureaucrats. Though the bill is a compromise, it still receives criticism from business groups generally sympathetic to Ashcroft. They say it would hold some businesses liable for certain health care decisions.

Carnahan bashes Ashcroft switch

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Governor Carnahan seems unimpressed with Senator John Ashcroft’s new-found support for HMO reform. Ashcroft voted for a republican alternative to the bill that Carnahan supports. Ashcroft defends his position, saying the earlier compromise would have opened employers to lawsuits. He says the latest compromise promotes arbitration. Carnahan says if his senate opponent had supported the earlier compromise, state residents would already be covered by the law’s benefits. He calls the move an “election year conversion” and complains that Ashcroft refused to support earlier compromise measures when he had a chance.

Business lobby cool to HMO reform

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A compromise on health care legislation is being discussed in Washington, but it hasn’t won over a critic in Missouri. Associated Industries of Missouri still stands opposed. AIM President Chris Long says the group remains opposed, because the bill still allows consumers to sue their employers over the health care they receive. And Long is unimpressed with the caps it would impose on any monetary liability awards. The compromise has won the support of Senator Ashcroft. He had opposed the legislation until now. Long refused to criticize Ashcroft for the switch. AIM is a traditional supporter of Ashcroft.

Ashcroft agrees to HMO reform

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Just one month before the most important election of his political life, Senator John Ashcroft has changed his position HMO reform. He has agreed to support a compromise managed care bill that he had previously opposed. Ashcroft says the bill protects more than 1 million Missouri residents. He says it also gives women unlimited access to OBGYN care, and allows children to use a pediatrician as their primary doctor. He says this version of HMO reform also promotes arbitration instead of lawsuits. He refused comment on whether business groups who have supported him in Washington agree with his new position, and denies he was under pressure to compromise during an election year.