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.

Republican lawmakers in red states are in a pickle. The Affordable Care Act requires each state to set up a health care exchange designed to bring down insurance costs for consumers. Republicans want no part of anything related to Obama's health care reform law, which they see as a federal intrusion on states rights. But if state lawmakers don't set up an exchange, the federal government will. In September, Republican senators in Missouri prevented the state from accepting $21 million of federal money to lay the groundwork for an exchange. Next door, the Sunflower State is in a similar quandary, reports Bryan Thompson of Kansas Public Radio.

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.

Able to clean teeth, like a hygienist, but also fill cavities like a dentist. If you've never heard of a registered dental practitioner, it's probably because they are only legal in two states, Alaska and Minnesota. Like nurse practitioners, these mid-level providers are aimed at helping underserved rural areas.