Missouri lawmakers are considering legislation that would control healthcare costs by placing payers, hospitals and other providers into risk-bearing delivery networks.
The bill, supported by Missouri Gov. Mel Carnahan, was introduced in the state Legislature earlier this month. It stems from proposals made last summer by two government panels-the "ShowMe Health Reform Initiative" and the Commission on State Health Insurance.
Under the proposal, the delivery networks would contract directly with large employers to provide three standard benefit packages. They would contract with individuals and small employers through the state insurance commission.
The legislation does not contain provisions for new taxes. Although its cost has not been estimated, proponents argue that the reforms can be financed through existing mechanisms.
The proposal, largely a reform of the insurance markets, would prohibit networks from denying coverage to individuals because of pre-existing conditions or for other reasons. It would create a community-rating system, initially modified to account for age, by Jan. 1, 1996. Under community rating, all subscribers are considered part of the same risk pool and pay a standard premium.
"We're really looking at this bill right now as a means to create insurance security," said Robert Frank, who chaired the ShowMe Health Reform Initiative.
The Missouri Health Care Insurance Board, a new body made up of state department directors, healthcare providers, insurance purchasers and members of the public, would oversee the system. Two other panels would develop quality measures, practice guidelines, medical record standards and plans to improve community health.
Although the bill doesn't require employers or individuals to buy insurance, it asks the board to develop a plan for universal coverage if the federal government doesn't enact such a law by Jan. 1, 1997. Also under the bill, delivery networks would be required to spend as much as 3% of their gross revenues on programs to improve community health and expand access to care.
Meanwhile, Missouri is seeking a waiver to expand its Medicaid system to more people. Details still are being debated, Mr. Frank said. Missouri enacted several reforms last year that added 28,000 people, mostly children, to its Medicaid rolls.