Health & Wealth Desk

Missouri state senators listened to over 3 hours of impassioned testimony on health care reform yesterday. The hearing was supposed to be on the rather mundane question of whether Missouri should set up an online health care exchange starting in 2014, or let the federal government do so. But the hearing quickly became a forum for debating the merits of health reform itself. After the jump, two interviews with senators on the committee: a Democrat representing one of the state's most liberal districts, and a Republican who has been at the forefront of Missouri's pushback against "Obamacare."

Missouri is ranked 50th among the states in funding for public health, spending about one third of the national average. Audrain County spends even less, just $7.90 per person. In this weekly Health & Wealth update, voters in Audrain went to the polls yesterday and approved a new property tax that will keep the county's struggling health department afloat. I spoke with reporter Garrett Bergquist, who has been driving around Audrain talking to voters.

Lt. Governor Peter Kinder takes aim at "Obamacare," and Democratic rivals. We discuss his legal challenge to what he calls "the federal health control law," and why he thinks his lawsuit will likely end up before the Supreme Court. We also cover some political turf: Kinder compares his style of leadership with that of Governor Jay Nixon. Missourians, says Kinder, "want a fighter, not someone who will lie down and just take dictation from our federal masters."

Missourians have never been in love with health reform. A year ago, Missouri was the first to pass a state law prohibiting an individual insurance mandate. It was a largely symbolic rejection of the Affordable Care Act, but now, more serious obstacles are looming. Missouri Lieutenant Governor Peter Kinder is one of dozens of officials from around the country challenging "Obamacare" in the courts.

In this weekly Health & Wealth update, the Affordable Care Act moves toward the U.S. Supreme Court. 

In the United States, we pay a lot more for our health care than other wealthy countries, but we are no healthier.  Missourians actually pay even more per capita than the U.S. average, and are even less healthy. (Missouri is ranked 39th in the nation in overall health, and we are the 9th most obese state.) A big part of the problem is the way we pay for health care, according to Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform.

During the Great Recession, as the ranks of poor and unemployed swelled, enrollment in Medicaid shot up, growing by 7.8 percent in 2009. At the same time, state tax revenues collapsed by nearly 17 percent. States couldn't afford to pay their share of Medicaid costs, and Congress came to the rescue with the Recovery Act, boosting federal Medicaid funding by around $103 billion. But the recovery dollars ran out in June, and now states are facing the biggest yearly increase in Medicaid costs in history, according to projections by the Kaiser Family Foundation. Missouri already spends over a quarter of the state budget on Medicaid.

In 2019, the average Missouri family will be $1,471 richer. That’s how much the average family will save on health care each year once Obama’s reform law takes full effect, according to a new study by Families USA, a pro-reform group. 

There’s a doctor shortage in rural America. This is not news – just the opposite – it’s been going on for ages. Even old Doc Adams, the country doctor in “Gunsmoke,” was constantly overworked. In one episode, when he finally gets a vacation, he’s kidnapped by outlaws in need of his services. Present-day Missouri ain’t Dodge City, Kansas. But many rural doctors are still overstretched. 

For people with chronic conditions, getting Medicaid services can be a confusing, disjointed experience, shuffling from provider to provider. Under a provision of the Affordable Care Act, states can apply for federal money to help coordinate that care. Missouri did just that, and the news came today that the state will be the first to get this kind of funding under the ACA. Missouri’s application was aimed at helping people with chronic mental health issues. 

End-of-life decisions can be wrenching for families. In the early 2000s, the case of Terri Schiavo riveted the nation, as her family battled over whether to remove her feeding tube or keep her on life support. Now, 44 states have so-called “family consent” laws, which help determine which family member should make health care decisions. Missouri is one of the six states with no such law, putting families and doctors in legal limbo. But a bill headed for the Missouri legislature could change that.

Two weeks ago, President Obama told the nation, “Washington has to live within its means.” As Democrats and Republicans continue to scour the federal budget for over a trillion dollars in possible cuts, one group very likely to be affected is rural hospitals in the Midwest and across the nation.

At public schools across the nation, internet filters keep students from looking at pornography and other material deemed harmful. It’s required under a federal law passed more than a decade ago. But now, one rural school district in central Missouri is at the heart of a national legal battle over whether schools may use this law to block websites that promote gay rights.

President Obama has been touring the country trying to sell voters on his American Jobs Act. According to the White House, the bill would, if passed, give the state of Missouri $700 million for transportation projects and cut the taxes of 120,000 Missouri businesses. And agriculture secretary Tom Vilsack says that rural areas in particular would benefit from the jobs bill. Vilsack spoke with KBIA’s Jacob Fenston.

Nearly one million more Americans were without health insurance in 2010, compared with the year before. That’s according to new Census numbers released Tuesday, which also show the Midwest has one of the lowest rates of uninsured in the nation. But even for people who have health insurance, understanding a doctor’s orders can be an obstacle to getting good care.