Better Get Your Tetanus Shot

Brad Cain, for HCPro, Inc., February 13, 2008

The latest news out of Missouri is that another state-led initiative to expand coverage for uninsured residents is about to fall by the wayside--an increasingly common trend on the healthcare reform front.

The program known as Insure Missouri was pushed through last year by Gov. Matt Blunt as a way to cover 200,000 Missourians, but is now facing stiff opposition because it goes too far, does too little, would cost too much or some combination of the three (depending on who you ask). The program would leverage existing federal matching funds against premiums paid into the system by individuals and small employers.

Initially the program would offer coverage to working parents and caregivers with children in families earning less than the federal poverty level. Later expansions would subsidize the cost of coverage for low-income working adults and offer a reinsurance plan for small employers. Coverage would be provided by managed care plans through the state's Medicaid program.

That the proposal is coming under fire is not surprising.

A few weeks ago, I wrote a column about San Francisco's legal battles to implement a program offering access to healthcare coverage for all city residents. Shortly after that column ran, I received this e-mail from a Missouri insurance regulator that offered some insight into that state's healthcare reform efforts.

"There's a lobbyist here in Jefferson City Missouri that's fond of comparing health insurance reform efforts to sticking your hand in a bag of rusty nails and broken glass. Legislators and regulators in Missouri recently stuck their hands in that bag. We haven't come up yet and we're already pretty cut up.

It seems to me that the ERISA/HIPPA/COBRA minefield is navigable, but it takes considerable expertise and experience. In Missouri, the bureaucrats (me) that have the expertise and experience couldn't make themselves heard by the legislators who desperately wanted to get a political victory on this issue. In addition, lawmakers in Missouri are term limited. There's just not enough time or capacity to adequately grasp every layer of complexity in our health coverage reform efforts. As a result, Missouri has a new law on the books that we can't implement or enforce without triggering prosecution from at least 4 federal agencies."

A key point in that e-mail is the reference to legislators lacking the necessary experience and expertise to adequately address the healthcare crisis. This problem is not limited to Missouri and seems to have been replicated in state houses across the nation. The problem, however, is not likely to be resolved anytime soon...kind of like the healthcare reform issue.

...And thanks for all the fish.

As an aside, this is my last column for Health Plan Insider. Les Masterson, editor of HCPro's Disease Management Advisor and the voice on the numerous audiocasts that have appeared in this space, will be writing a column for HPI beginning next week.

Brad Cain is editor of California Healthfax and executive editor for managed care with HealthLeaders Media. He may be reached at
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