Before Christmas, Matt Blunt was busily trying to get past his Ebenezer Scrooge image by announcing three different forms of state government largess that he is proposing.

The first is a $121 million dollar increase in state aid to education–four percent more than the state is spending now. Blunt neglected to mention, though, that the added funds are hardly prompted by the Mother Teresa portion of his soul. Rather, it is a raise mandated by the new school foundation formula.

The other two examples of his munificence and his concern for the poor have to do with his two replacement programs for Medicaid. MO HealthNet is Medicaid under a jazzy new name–and covering fewer people than the old program did. Insure Missouri is for the working poor.

Blunt is recommending that doctors treating patients under MO HealthNet receive more appropriate compensation. In 2006, they got only 45 percent of what doctors were paid for treating Medicare patients. The 2007 budget bumped the payout up by $66 million, so that doctors received 55 percent of the Medicare reimbursement rate. Blunt is proposing to add another $52.8 million a year starting July 1, so that doctors treating Medicaid patients would receive at least 65 percent of the Medicare payment rate.

Blunt’s recommendation to raise MO HealthNet compensation is, like his proposal to raise education spending, disingenuous, since the bill that created MO HealthNet dictated that the minimum rates would rise. It’s not like the governor woke up one morning and decided to raise those rates so that more of the poor could find doctors who would treat them. The bill already spelled that out.

Still, despite the guv trying to take credit where it isn’t due, it would be heartening to see a more reasonable rate of compensation, because many doctors have begun refusing to treat Medicaid patients. Don’t hold your breath, though. The increase in payment rates to doctors isn’t likely to happen anyway because the money for it probably won’t be there. And Blunt knows that.

No matter what a given bill says the state must spend on something, states aren’t like the federal government: they may NOT engage in deficit spending. First and foremost, they must balance their budgets. And Missouri is on a list of thirteen states that are projected to have a budget shortfall in fiscal 2009, which begins this July.

And no matter what the MO HealthNet bill may have mandated, the money for paying more to doctors of Medicaid patients hasn’t been included in the budget. If we have a budget shortfall–as the downturn in the economy and the housing market makes more than likely–some programs will have to be cut (or taxes raised–as if). And the programs that are at least in the budget to start with–like the increased money for education–are more likely to get the funding. Raises for doctors of Medicaid patients will be left out in the cold like orphans.

Finally, on the list of Blunt’s recent bounty, we come to Insure Missouri, the health insurance program for the working poor.  The first of its three phases, for working people who live below the poverty line, is budgeted and due to start this February. But the other two phases still have to get through the legislature. Lotsa luck.

Fiscally conservative Republicans liked the way those Medicaid cuts two years ago helped the budgeting process, and they’re not inclined to undo what they accomplished. They’ll oppose it. That might not be a problem if Dems would vote for it, but they’re not itching to give Blunt that kind of legislative victory in an election year, especially since they figure he’d fund it just long enough to get himself elected and then let it wither. That’s what he did in 2004 with Medicaid–promised during the campaign that he would continue to fund it and then axed it in 2005.

So don’t count on the next two phases of Insure Missouri to materialize. Blunt will make all the noise he can about his fiscal beneficence. But however much he crows, the noise may only serve to remind taxpayers what a stingy ass he was three years ago.

It’s a tough call for the governor: shut up about health care and pray for short voter memories or try to undo the lingering pr damage. Looks as if he’s opting to brag.

Crow, Chanticleer.  

Photo courtesy of Missourinet

Some of you may remember reading my September 24th posting “A Summary for Dummies of Missouri Health Care for the Poor”. Bet you don’t remember what it said, though. I wrote it, and I didn’t remember until I reread it. But since I’ll have things to say soon about MO HealthNet and Insure Missouri, I’m reposting that September 24th explanation. You know how it is with us retired teachers: we never quite cure ourselves of “review day”.

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.

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.