Report From the States

Missouri State Legislator Impedes Health Reform

Conrad F. Meier

No one can question Missouri state representative Tim Harlan's (D-Columbia) desire to reform health care. The question is how?

During the 1998 state legislative session, Rep. Harlan introduced a bill that would have allowed uninsured employees of small businesses to buy into the state employee health plan. His idea was defeated. Likewise, during this (1999) session, Rep. Harlan rebounded with a new plan called "Rate-Compression," a camouflaged version of price-controls. Again, fortunately, he ran into opposition.

Three pro-consumer health care bills were introduced that would have clearly helped address the problem of insurance cost: One allowed for a 100 percent tax deduction for insurance premiums; a second allowed line-item tax deductions for out-of-pocket medical expenses; and a third would have lowered the eligibility cap in Missouri's high-risk insurance pool from 200 percent of the standard premium rate to 135 percent and provided employers the right to deduct the premium cost for employees. The consumer benefits of the first and second bills are obvious. Many citizens who are uninsured due to economic reasons would have found health insurance more affordable.

The third would have lowered the cost of high-risk pool insurance for the medically uninsurable, hence expanding access to more Missourians with pre-existing health conditions. Moreover, those individuals who became eligible under the rules of Health Insurance Portability and Accountability Act of 1996 legislation could buy into the high-risk pool instead of being forced into the individual health insurance market.

These bills passed the house while Rep. Harlan's price-control plan languished. The legislator then maneuvered to combine all three pro-consumer bills with his anti-consumer legislation into one titanic omnibus health care bill. This effort ran into major trouble in the Senate.

This time Rep. Harlan tried and failed to have his omnibus bill added as an amendment to a related mental health parity bill already in the state Senate and destined to pass. The overweight omnibus bill never made it to the Senate floor for discussion and the 1999 session was adjourned. State senators spent much of their time deliberating on a $180 million tax cut and calculated Rep. Harlan's omnibus bill would cost upwards of $150 million more.

There are a number of issues here, but for this report, suffice it to say, this self-serving procedural maneuvering ruined any chance for just one of the three consumer-friendly bills to pass. Any one of the three, as stand-alone reform, would have been a major step forward on behalf of Missouri residents struggling with health insurance premium inflation.

Yes, Rep. Harlan wants to reform health care. He just needs someone to show him how to do it.


Mr. Meier is health policy advisor for the Chicago-based Heartland Institute. He writes a bimonthly opinion column for Broker News Publishing, Group, Inc. and is Assistant in Research, Center for Advance Social Research, University of Missouri. E-mail:

Originally published in the Medical Sentinel 1999;4(5);186. Copyright©1999 Association of American Physicians and Surgeons (AAPS)