The Senate version of the bill, called "Show Me Health Care," would cover about 35,000 uninsured parents who make too much to qualify for Medicaid, said bill sponsor Tom Dempsey, R-St. Charles County.
But the House committee substitute released Thursday would change the eligibility requirements. Rather than covering uninsured parents, the proposal before the committee would change the objective to covering people who are uninsurable due to preexisting conditions.
Rep. Rob Schaaf, R-St. Joseph, said the state shouldn't spend money on covering people through what he called a welfare system. Instead, the state should spend that money on people who are precluded by insurance companies from purchasing insurance, said Schaaf, a practicing family physician.
"When you go to Walmart when you're a disabled person, you can buy anything on the shelf. But if there was health insurance available at Walmart, you wouldn't be allowed to buy it. Just because of the fact that you're disabled. That's outrageous," Schaaf said.
Some of the new language for the substitute is modeled after a bill by Rep. Doug Ervin's, R-Holt, but that legislation is being rolled into this one.
"If the legislature passes any health care legislation this year, it'll be this bill," said Rep. Dough Ervin. Ervin, R-Holt, had sponsored a similar measure to expand coverage for persons with pre-exisiting conditions.
Using the same funding mechanism -- federal funds given to states for treatment of the uninsured in the emergency room -- Ervin said the new proposal will cover 20,000 uninsurable people. Ervin said he is against Dempsey's original proposal because he has "no interest in expanding welfare."
Several House Democrats however, said they would prefer to expand Medicaid instead of insuring 35,000 more through Dempsey's plan or just focusing on the uninsurable.
Rep. Mary Still, D-Columbia, said she is not likely to vote for the bill, either in the Senate version or the House substitute.
Still estimates the number of uninsurable persons at 3,000 in Missouri and said that because of the six-month waiting period for high risk pool qualification, many of these people go without care when they need it most. She said she supports Gov. Nixon's plan to expand Medicaid -- a plan met with resistance in the Republican-controlled legislature.
Still said she sees all the efforts introduced by Republicans as "camouflage for the fact that the majority party has cut Medicaid and it has hurt the economy, hurt their constituency, and hurt their chances for reelection."
Other Democrats wanted to remove the three to five year limit on coverage under Dempsey's Senate-passed plan.
Another concern has been the long-term costs to the state's budget in establishing a new level of health care coverage.
But Dempsey argues his plan can be financed through existing federal funds that the state uses for paying medical facilities for the care they provide to the uninsured.
"Not one dollar of the funding for this program comes from new money. I'm looking at how we can take existing money on better care that's less expensive," Dempsey said.