JEFFERSON CITY - If Missouri lawmakers have their way, Missourians will move towards mandated health care coverage one body part at a time.
Under various bills filed in the legislature, HMO's and other insurers would have to pay for contraception, pap smears, colorectal exams, prostate exams, medication for chronic illnesses, experimental drugs, and may have to offer better mental health care.
The type of illnesses getting legislative attention has prompted some to coin the phrase "private parts" insurance legislation.
Patients will also be able to sue their HMO's for denial of care, and HMO's will be forbidden from offering doctors financial incentives to reduce care.
And even that's not all of this year's legislation. "There's an enormous number of mandatory regulations brought before this session," said Brent Butler, lobbyist for the Missouri Insurance Coalition.
"What people need to realize is that for each mandate, there is an added cost," he said.
Insurance and HMO advocates warn those costs simply are passed on to consumers in the form of higher health care premiums.
Some lawmakers denied the burden will be that onerous. "No, this is just patient's rights, it's people who are sick and can't help themselves," said Sen. Harry Wiggins, D-Kansas City.
Lanis Hicks, an M.U. health management professor, warns against what she calls "relying on anecdotes" in making health-care legislation. She suggests we should focus on broader issues.
"We're starting to micromanage health care. What's happening is that everything that's making managed care affordable, we're shooting down."
Hicks adds that this trend, along with new technology and services, is what's driving up the cost of health care.
But Rep. Tim Harlan, D-Columbia, has a different perspective. "There are people who say they're opposed to any mandate," he says, "but in 1997 we mandated that insurance companies cover reconstructive surgery after a mastectomy. No one says they're opposed to that. So I think we have to judge each mandate on its own merits."
Sen. Bill Kenney, R-Lee's Summit, whose bill requires coverage for some cancer tests, says lawmakers need to make HMOs insurance companies perform adequate preventive care. "My bill just follows American Cancer Society guidelines," he added.
One of the insurance industry's arguments against some mandates is that by making demands of all group and individual health insurers, effective competition is eliminated. Many in the industry say the insured - or their employers - should be able to choose the quality of coverage they'll provide.
Another problem is that rising costs may simply increase the number of uninsured Missourians.
Butler wouldn't speculate as to what new coverage mandates would pass. But he did support for a bill, sponsored by Harlan, to establish a benefit review commission to weigh the merits of mandates Missouri already has.
Harlan's bill also seeks to make health insurance more affordable for small business. Last year, Harlan proposed allowing small businesses to buy into the state-employee comprehensive health plan, but was thwarted by opposition from insurers and public employees.
This year, Harlan is proposing tax credits to make insurance more affordable for small businesses.
"This is a huge issue," Harlan says, "I don't think it was such an enormous problem in the 1950's, I've been been reading a lot of insurance history to find out what's happened to us."