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GOP Health Care Plan

State Capital Bureau

March 10, 1995

JEFFERSON CITY _ A Republican state senator is hoping his scaled-back approach to health insurance regulation will have more success than larger, more encompassing Democratic bills now before the body.

Senate Minority Leader Franc Flotron, R-St. Louis County, presented his insurance regulation bill to the Senate Insurance Committee Wednesday (March 8). The bill would impose some restrictions on insurance companies from excluding or limiting coverage based on pre-existing conditions.

However, the measure still does not totally ban restrictions based on pre-existing medical conditions.

An insurance company could limit coverage for up to nine months for a person with a pre-existing condition if the person seeks to expand existing coverage or purchases the insurance more than 30 days after losing previous insurance coverage.

One of the goals of Flotron's bill is portability _ allowing consumers to remain insured when they change jobs. To achieve portability, the bill requires insurers to sell coverage to those who had been covered within the previous 30 days.

Regulating peexisting conditions exclusions and portability would address the problems of the "vast majority" of those who aren't covered, Flotron said.

"It is an incremental step that I think would solve 70 or 90 percent of the problem, and it does so without any tax increase, without any big bureaucratic burden on society," Flotron said.

Flotron compared the Health Insurance Access Act, sponsored by Sen. Ed Quick, D-Kansas City, to Gov. Mel Carnahan's health care package from this past session.

"After this last election, I think there's a real philosophical change," Flotron said. "I would be very surprised if the legislature would pass a big-government-solution type of health-care bill."

Although Quick's bill has been approved for full Senate debate and Flotron's has not, Flotron said his own bill could still be used as a vehicle for insurance regulation.

"I suspect if Sen. Quick's bill does make it to the floor, I will offer mine as a substitute for his," Flotron said. "If it makes it to the floor, I think mine is way more likely to pass."

Many insurance industry lobbyists support the nine-month limit on coverage of pre-existing conditions that is included in Flotron's bill. They say it is a way to protect insurance companies from being taken advantage of by consumers.

"What you don't want to have is a person who doesn't have coverage, who knows they're going to have an operation that costs several thousand dollars and then buys coverage, keeps it for three or six months and drops it," said Mark Johnson, a lobbyist for Blue Cross/Blue Shield.

Insurers call this tactic "gaming," and it hurts more than just the company, Johnson said.

"All that does is raise rates for everybody else because that money has got to be recovered somewhere else," he said.

Opponents of the bill say it will raise premium rates for consumers.

"The elimination of pre-existing conditions exclusion clauses will raise premiums, based on our actuaries' ballpark figures, between 12 and 15 percent for the individual market and between 8 and 10 percent for the small group market," said Tom Sams, a lobbyist for Golden Rule Insurance Company.