JEFFERSON CITY - The biggest failed issue of the 2006 Missouri legislative session very well could be efforts to deal with the June 30, 2008 termination of the state's largest welfare program -- Medicaid.
Minimal action was taken by the legislature this year, leaving the bulk of the burden on next year's session.
Cracking down on Medicaid provider fraud, creating a health care technology fund, and restoring some disabled workers back onto Medicaid were measures Gov. Matt Blunt and legislative leaders planned on achieving, yet all three issues were blocked from a final vote in the House.
Rifts amongst leadership in the state House, Senate, and with the governor contributed to the inaction.
Last year, the legislature adopted a "sunset" for Medicaid to take effect in the middle of 2008.
While the legislature technically has two years remaining to address the issue, adoption of anything in 2008 would require a two-thirds majority to take effect before the June 30, 2008 deadline.
During the legislative session of 2005, state lawmakers made deep cuts from the $6 billion program in an attempt by the Republican-led body to hold down the growth of welfare spending.
The 2005 session also brought about the expiration date for the program and the creation of a Medicaid Reform Commission committee, consisting of five members from the House and Senate, six Republicans and four Democrats.
The committee began working on Medicaid reorganization after the 2005 session and released an extensive report in January of this year on their findings and recommendations for program.
The committee's recommendations included dealing with Medicaid fraud by health-care providers and formation of a health care technology fund.
Both issues died in Missouri's House which refused to take up the proposals on the legislature's last day.
Sen. Chris Koster, R-Harrisonville, was appointed to the head of the Special Committee to Investigate Medicaid Fraud, which held exploratory hearings and conducted extensive research on the issue of Medicaid fraud in Missouri.
Taking what the committee found, Koster filed a bill providing legal tools to go after health-care providers that cheat on Medicaid.
"At least three and a half percent, or about $200 million, of Missouri's Medicaid money evaporates through fraud abuse," Koster said in a Senate committee hearing earlier this year.
Key provisions to compensate whistle blowers and increase punishment on those found guilty of provider fraud highlighted the legislation.
The bill moved through the Senate with relative ease, as Gov. Matt Blunt supported the measure.
But the bill ran into stiff opposition from the House Healthcare Facilities Committee, chaired by a practicing physician.
Rep. Robert Schaaf, R-St. Joseph, warned that some of the provisions in the Senate-passed bill -- such has allowing private citizens to sue providers for suspected Medicaid fraud -- would drive doctors and other care-givers out of Medicaid.
The House committee proposed a much weaker version of the bill -- but the committee's substitute was never brought up on the House floor.
The final package the House refused to consider also included restoration of Medicaid coverage for some disabled workers (a program called Ticket to Work) and establishment of a health care technology fund.
The technology fund proposal, endorsed by the governor, would have provided grants for health-care providers to computerize medical records.
But House leadership opposition to the Medicaid fraud provisions kept the omnibus Medicaid bill from a House vote.
Sen. Pat Dougherty, D-St. Louis, said a "crisis of the month" attitude in the legislature took away from the Medicaid debate.
"The focus was off restoring Medicaid," he said. "It should've gotten more attention. I think Democrats did a good job of trying to explain what would happen if we made those cuts last year. We (Democrats) just have to work with the cards we're dealt with right now."
Senate Republican Leader Charlie Shields chaired the Medicaid Reform Commission. He said the despite legislative inaction, the state's Social Services Department has made progress.
"There's been a lot of work done within the department as far as what's been implemented," Shields said. "They've kept things going for us in the meantime."
But Shields predicted Medicaid would return to the legislature next year -- in a big way.
"Medicaid, or its successor, will dominate the discussion next session," Shields said. "These issues will be back next year."
Reform commission member Rep. David Sater, R-Cassville, agreed that small steps are being taken and that progress will continue throughout the next year.
"A few things have been done to improve the system, we've taken many recommendations," Sater said. "It's important for us to work closely with the governor to develop comprehensive solutions for Medicaid and all health care needs in the state, which I believe we are doing."
Sater said he does not want the health care reforms to only focus on the uninsured though.
"Our goal is for everyone in Missouri to have coverage, some kind of health insurance, whether it be from private sources, Medicaid, or a combo of both," Sater said. "We need to look into increasing health care saving accounts for the uninsured, allowing them to buy high deductible plans to pay for normal preventive care, and still have a policy for larger surgeries."
But the slow, stalling activity is seen by some, namely Democrats, as the worst possible way to fix the problems. Dougherty pointed to the widespread cuts to the system in 2005 as the antagonist for the current crunch.
"It was a mistake from the beginning, in a fiscal crisis that we were in, to put the blame on Medicaid and cut so many citizens from it," he said.
"Cutting people, then fixing the system hurts the most for people," he said. "It's the wrong way to go about reform and the method we've gone about it is probably a grave mistake."
Dougherty said he would to see an intense, engaged process where professionals, physicians, and lawmakers work together.
"All these folks have to constantly be at the table, not just visiting," he said, in reference to future Missouri health care decisions.
Rep. Judy Baker, D-Columbia, expressed concern for the manner in which the state's overall health care is handled and was disappointed that nothing substantive has come from the Medicaid Reform Commission report.
"It has not been a coordinated, bipartisan effort at this point," said Baker, an health care consultant.
Baker also worries about Missouri losing federal funding due to the many uninsured health care patients around the state. She pointed to Massachusetts as a state taking advantage of the funding by insuring citizens.
"Every month we waste on these issues, the more money we lose," she said. "Massachusetts received large amounts of federal funding to expand their health care programs and to cover as many as possible. We haven't sufficiently addressed the growing number of uninsured people due to last year's cuts."