JEFFERSON CITY _ The Missouri General Assembly's two-year struggle to achieve some form of health-care regulation has shown how quickly an effort's failure can change strategies and redraw battle lines.
In the 1995 legislative session, opponents of last year's health-care packages seem to have switched roles with their former adversaries.
The push for health-care regulation originally came last year from Gov. Mel Carnahan and the Democratic leadership. They were opposed mainly by Republicans, health insurers and the medical community.
But during the 1995 session, one of the major health-insurance regulation bills was created by representatives of the medical community and the other was co-sponsored by the Republican minority leader, Sen. Franc Flotron, R-St. Louis County.
At the same time, Carnahan and the Democratic leadership have backed away from the issue of health-care regulation.
Last year's fight over the issue began with the governor pledging a fundamental overhaul of Missouri's Medicaid program. The state applied for a Medicaid waiver from the federal government, which would allow Missouri to design its own health care system.
The waiver request is still pending before the federal government.
If approved, the waiver would free Missouri from national Medicaid requirements and give the state total control over its $2 billion welfare medical budget.
In a separate move last year, Carnahan proposed to lawmakers a plan for comprehensive regulation of the health industry and health insurance.
Originally, the plan included provisions requiring the health industry to set aside a certain percentage of profits for public health services. The plan also required the industry to form Integrated Service Networks under which physicians coordinate health services through agreements among different health care providers.
After the plan encountered stiff opposition from physicians, the Carnahan administration shifted the emphasis away from these provisions to others dealing with health-insurance regulation.
These insurance regulations required insurers to sell coverage in standard benefits packages at standard rates by region, to offer an annual 30-day open enrollment period, and to stop excluding patients based on preexisting conditions.
After bitter debate, the General Assembly failed to pass the governor's plan. Carnahan blamed insurance industry lobbyists for his plan's defeat, but he vowed to continue the fight for health care regulation.
However, at a news conference after his State of the State Address in January, Carnahan said he had dropped the health package from his program for the 1995 legislation session.
Another fight in the General Assembly would be futile, he said.
In lieu of a health package put together by the governor's office, representatives of the medical community drafted their own plan, and Sen. Ed Quick, D-Kansas City, agreed to sponsor it.
This "Health Insurance Access Act" contains many of the health-insurance regulations included in the governor's plan from the previous session. The act includes standard benefits packages, portability, and an open enrollment period.
The measure also would prohibit insurers from refusing to cover individuals with preexisting conditions and require insurers to sell coverage at standard rates by region. The bill currently is waiting to be debated in the Senate.
The other major health regulation bill of this legislative session was created by an ad hoc medical group and co-sponsored by Flotron. It includes protections for consumers and medical-care providers.
The "Patient Fairness Act" would prohibit an HMO from arbitrarily rejecting applications by medical care providers _ such as doctors _ to be included in the health care plan.
HMOs also would have to tell applicants why they are rejected.
The bill also would require HMOs to explain benefits packages to consumers in easily understood terms. During floor debate, the Senate approved an amendment to require HMOs to be certified by the state.
The measure was approved by the Senate, but Flotron predicted the bill would face an uphill battle in the House.
"This bill is often compared to "any willing provider" legislation, and typically what happens is (that type of) legislation passes the Senate and gets clobbered in the House. I think this is likely to follow the same pattern."
Flotron blamed political motivations for the governor's abandonment of a package for health insurance regulation this year.
"Last year the Governor thought it was the year for health care," Flotron said. "The situation hasn't changed since last year, all that's changed are the political winds. (The governor) is trying to avoid any of the leftist agenda items from last year, and this is one of them."
But Quick disagreed.
"I don't believe there's a decrease in interest," Quick said.
"I think some of the people worked so hard on it last year and didn't get anything passed, so they're waiting to see what happens with (my bill)," he said. "If it looks like we might be able to make it move, I think you'll see that interest flare back up."
Problems such as portability and exclusions based on preexisting conditions still need to be addressed, Flotron said, mentioning a separate bill he filed which only deals with these issues.
"Sen. Quick has a revised version of the governor's health-care bill from last year on the calendar, and I have every intention of offering my bill as a substitute for his should it get to the floor," Flotron said.
Barring any unexpected developments, Quick said his bill does have enough time to get to the floor for debate. But the bill has "faced an uphill battle from square one," Quick said, and it is difficult to determine the chances of passing it this session.
"It came out of committee in very good condition," Quick said.
"But it will take a lot of debate," he said. "I'll get it up there and suggest that this is the thing to do, and maybe somebody will come up with a better idea. But Flotron's bill is not it."
With only weeks before the legislature's May 12 adjournment, however, prospects for passage of any significant health-insurance package this year would appear dim.