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You say you can’t keep track of all the health care plans for the poor popping up in Missouri lately?  You say that a news article about the pros and cons of them causes your eyes to cross?  You ought to be ashamed to find yourself in the lower … what? 98 percent? … of the citizenry.  That makes you–and me, until tonva brought me up to speed–dummies.

But now that she’s educated me, I’m here to do the same for you.  Succinctly.  Before your eyes glaze over.

When it was just Medicaid, we dummies could grasp the situation.  Essentially, the state paid 40 percent of medical bills for uninsured people below a given income, and the feds paid 60 percent.  Then a couple of years ago, Republicans knocked more than 100,000 poor Missourians off the Medicaid rolls.  Ah, but they promised to come up with something better than Medicaid in a year or so. 

Now–with an election looming and Matt Blunt polling under 50 percent–they’re offering two new programs to replace Medicaid.  And these programs would restore health care to many, though by no means all, of those who lost it in 2005.  Between the two programs, it turns out that some poor people who used to qualify for Medicaid will still be denied care, while others, who didn’t have it before, may get care. 

The two programs are MO HealthNet and Insure Missouri.  Here’s the difference between them in a nutshell: 

MO HealthNet is just Medicaid by a jazzy new name, and it still doesn’t restore those 100,000 people to the rolls.  The only important difference is that MO HealthNet will be administered through insurance companies.

Insure Missouri is for the working poor.  It will be funded partly by the state, partly by an existing tax on hospitals, and partly (it is hoped) by the federal government.  It too will be administered through private health insurance companies.

One good part of Insure Missouri is that some of those 100,000–if they’re working–will be covered again, but seniors and disabled people are out of luck. 

A second good aspect of Insure Missouri is that it covers people with a higher income than Medicaid ever did.  Medicaid was for people who lived below the federal poverty level.  This program covers working people up to 185 percent of the federal poverty level (FPL).  (But if they earn more than 150 percent of FPL, they must pay premiums–which they’d have trouble affording.)

Now for the glitches with Insure Missouri.

  • Since it’s partly a Medicaid program (covering people below FPL), Blunt is hoping for federal funds.  Those are by no means certain.
  • Many of those who qualify live in rural areas where there are no HMOs to administer the plan.  Perhaps HMOs will spring up there if doing so looks profitable enough.
  • And the big one:  the plan is administered through private health insurance companies.  Question:  WHY?  (Answer:  Insurance companies contribute to Republican campaigns.)


Both MO HealthNet and Insure Missouri could probably cover the same number of people for one third less money if they were simply administered through one of the state’s social agencies, such as the Department of Social Services.

Jack Cardetti, a Democratic spokesman, commented:  “‘Only Matt Blunt would call lining the pockets of the Missouri health insurance industry health care reform.'”

In the end, Insure Missouri may just be pie in the sky.  It might never happen.  Here’s why:  it will come in three phases, starting in February and at that time covering only working parents below FPL.  That money is already in the state budget.  But the other two, more expensive, phases will have to be voted on by the legislature, and quite a few Republicans are looking on it with a jaundiced eye.  They see budget shortfalls looming in 2010–as a result of their policies–and they’re already protesting that the state cannot afford those two phases of Insure Missouri.

Look for a lot of intra-party conflict.  But even if Blunt loses the battle for the expensive two-thirds of Insure Missouri, he’ll claim loudly that he fought the good fight to get health insurance for the poor in this state.  (Well, not for poor disabled people and poor seniors, but you can’t have everything, right?)

And most citizens won’t be able to make heads or tails of it all.  It’s too confusing.  Deliberately so.  Insurance companies and the politicians who cater to them like it that way.  They want our eyes to glaze over.  That makes it so much easier for them to hoodwink us.