HEALTH BILL PROPONENTS PUSH FOR IMPROVED ACCESS

A major health-care legislative package supported by top leaders of the House and Senate and Gov. Mel Carnahan would improve access to health care for 600,000 Missourians with inadequate care, members of the Health Policy Institute said Thursday.

"This is not a reform bill; it is an access bill," said Judith Widdicombe, president of the institute.

Widdicombe and Alison Gee, director of research for the group, are traveling the state meeting with news media representatives and health care officials to explain the importance of the bill.

The measure, sponsored by House Speaker Bob Griffin, has passed the House and will likely be taken up by the Senate next week. Senate President Pro Tem James Mathewson is personally handling the bill.

Widdicombe said the governor signed on to the package Monday night. He predicted strong support of both the legislative leaders and the governor increased the likelihood of passage this year.

Even though health care reform is a major topic at the federal level, Widdicombe said the bill would lay a foundation for future federal action and anything done at that level would not alter the impact of the bill.

"We are laying in place an infrastructure with this bill," said Widdicombe.

She said about 1.1 million Missourians are uninsured or underinsured, and that the plan would improve the access to care for two-thirds of those people.

"A lot of this involves just hooking up people who are eligible with the system," said Widdicombe, adding that in some cases it is a matter of health care providers taking services to people.

Gee said, "There are a lot of programs people are eligible for but don't know about or just can't get to the services."

Widdicombe said hospitals are beginning to recognize that changes are coming in the health care profession and are beginning to make changes that will break down some of the institutional barriers.

In fiscal year 1994, which begins July 1, the legislation would cost $23 million in state funds, and would be supported by additional federal matching funds.

Funding for the package would come from increasing the excise tax on cigarettes by 4 cents a pack and by assessing a tax of 10 percent of the manufacturer's invoice price.

Griffin explained in a written statement that he believes access to health care has reached "epic proportions because of the intangible nature of its symptoms." When citizens do not receive adequate primary and preventive care, the end result will be emergency medical situations, he said.

Griffin said his bill was developed after spending nine months with experts in the field of health care and seeking ways to shift the state's focus from critical care to primary care. He said the bill will "dove tail" with what could be coming in national health care policies.

"I do not pretend that this bill will solve all the health care ills in the state," said Griffin. "What I do believe is that this legislation is an important first step towards increased access to affordable and cost-effective health care for all Missourians. With a minimum investment, my bill will give access to primary and preventive care to 600,000 Missourians through two million new points of access."

Widdicombe and Gee said the plan would be overseen for four years by a joint House-Senate committee, to monitor and evaluate the effectiveness and efficiency of health policy statewide. The group would also mandate internal evaluation by department on the effectiveness of programs implemented by the bill.

A key part of the bill is that it will allow schools do decide to become Medicaid providers so that schools could receive funding for primary care services for school-age children under 200 percent of the poverty level. The bill also provides funding for school nurses, which many school districts have eliminated during rounds of budget cuts.

Widdicombe explained that many children are entering school with serious medical problems because their families lack health insurance or access to medical facilities. She said she believes that the school program, which would serve both public and private schools, will help deal with medical problems early to improve students' health and their ability to focus on learning.

Another provision of the package allows physicians to establish written collaborative practice agreements with registered professional nurses to provide health care. It also allows advanced practice nurses, under written agreements, to write a prescription.

The bill, however, does not give nurses independent prescriptive privileges. This provision should make it easier for doctors and hospitals to establish clinics in nearby towns, said Gee.

A state legal defense fund would also be established to offer malpractice insurance to professionals who donate primary and preventive care to charity patients.

The bill also has a provision to establish medical loans for students that could be forgiven, and other incentives for doctors to practice in areas where it is difficult to attract doctors.

Some of the other parts of the bill would allow for the establishment of individual medical accounts, community substance abuse grants, expanding Medicaid coverage, and it directs the Department of Social Services to make greater efforts to inform uninsured and underinsured people about state and federally funded programs they might be eligible for.

Griffin pointed out that Missouri's tax on cigarettes is now 13 cents a pack and has not been raised since 1982. Only six states have lower cigarette taxes than Missouri.