JEFFERSON CITY, Mo. – A combination of forces could sidetrack health care measures awaiting consideration as the Missouri General Assembly moves through the second half of its legislative session, which began this week.
The biggest roadblock, according to some observers, is the uncertainty surrounding the federal health-reform law. Constitutional challenges to the law are pending before the U.S. Supreme Court, and it might take until June for the court to render a decision.
“I don’t see the Legislature this session doing much on health care,” said Andrea Routh, executive director of the Missouri Health Advocacy Alliance, a coalition aimed at improving health care for consumers. “And in large part that is because they want to wait and see about the Supreme Court and whether the Affordable Care Act stands.”
One proposal the hesitation could affect is Senate Bill 464, which would prohibit the executive branch from implementing a health insurance exchange without input from the General Assembly.
As passed in the Senate, the measure specifically prohibits the establishment of an exchange by an executive order issued by the governor, reflecting Republican concerns over potential action by Gov. Jay Nixon, a Democrat.
“It is something so big that one man shouldn’t decide,” said state Sen. Rob Schaaf, a St. Joseph Republican and sponsor of SB 464.
The bill includes a referendum clause, which would bypass any potential veto by Nixon and put the measure to a statewide vote in November for final approval.
Health insurance exchanges are a central component of the Affordable Care Act. They are designed to give individuals and small businesses access to affordable, basic health insurance.
Under the law, states have the authority to craft their own exchanges. But if they pass on that option, the federal government will implement the exchange with the goal of having one up and running by the statutory deadline of Jan. 1, 2014.
According to Schaaf’s chief of staff, Chris Dunn, the Missouri Department of Insurance has stopped efforts to establish an exchange because of the General Assembly’s opposition and to await the Supreme Court decision. Insurance Department spokesman Travis Ford wasn’t immediately available for comment.
Schaaf did not express any worries that his measure would be held up by a wait-and-see attitude in the General Assembly. His concern was that the bill might be amended during the legislative process to include other health care language that he opposes.
Schaaf said he was optimistic about the prospects for the measure, in part because the majority leader in the House of Representatives had agreed to handle the bill in that chamber.
Patrick Ishmael, a policy analyst with the conservative Show-Me Institute, had a different reason to be optimistic about Schaaf’s measure. He said the referendum clause makes it easier for lawmakers to consider, since approving it simply means sending the issue out to the voters.
“My impression is that it would probably look like it does now (without any significant amendments),” he said, “and it would be decided by the people.”
Routh also said election-year caution could scuttle any controversial health care legislation such as measures (SB 679/HB 1371) to broaden the authority of advanced practice registered nurses. Among other things, those measures would allow the nurses to prescribe medications outside of a collaborative practice agreement with physicians.
Even under the best of circumstances, Routh said, lawmakers hate getting in the middle of turf battles like this one between doctors and nurses. And in an election year, she said she doubted lawmakers would want to antagonize either group.
“So, I don’t anticipate that the bills will move unless by some miracle the nurses and physicians can sit down and negotiate a compromise,” she said.
The last action on the Senate measure was a committee hearing in February. The House version is schedule to be discussed today [March 21] at hearing before the Professional Registration and Licensing Committee.
Another reason why health care measures might not pass this session is that the General Assembly has higher priorities.
Sen. Jolie Justus, a Kansas City Democrat, said it seemed that business and labor issues had precedence this session, and Routh said budget issues were dominating as well.
But given the unpredictability of the legislative process, a couple of measures on the radar screen of the Missouri Health Advocacy Alliance could suddenly gain momentum.
Those are SJR 39, a proposal to exempt Missouri from the Affordable Care Act through a constitutional amendment, and measures (SB 710/HB 1193), which would attempt to crack down on prescription-drug abuse by tracking filled orders in a state database.