JEFFERSON CITY, Mo. — Gov. Matt Blunt’s plan to increase health care access is one patient making little progress this week in a political “game of chicken.”

At stake is an Insure Missouri proposal to provide insurance to roughly 200,000 more Missourians that the governor already put on hold once because of legislative opposition.

House Speaker Rod Jetton, R-Marble Hill, and Rep. Dr. Rob Schaaf, R-St. Joseph, now won’t budge if the bill enacting Insure Missouri doesn’t include measures to increase hospital competition.

Keeping the bill in gridlock with three weeks in the session remaining, the Missouri Hospital Association is using its weight to stop any of the proposed reforms to the Certificate of Need program. Any new hospital must undergo the lengthy CON process in order to operate.

In light of the standstill, a budget committee this week slashed funding for Insure Missouri.

“It certainly shows the House and Senate don’t have a lot of hope,” said Rep. Doug Ervin, R-Kearney, whose bill to enact Insure Missouri was combined with one from Dr. Schaaf.

Mr. Ervin said the St. Joseph Republican and the speaker have “absolutely” killed the bill, as Mr. Jetton won’t bring it up for debate unless he believes enough votes exist to support Insure Missouri tied to CON reforms. The Missouri Hospital Association is heavily lobbying legislators to reject CON changes and has gained much ground.

Theoretically, if the Legislature ultimately passed it, the money for the program wouldn’t exist unless lawmakers then OK’d a budget supplement, Dr. Schaaf said Thursday.

But he and the speaker didn’t convey much optimism.

“I’m using my influence to say we’re not going to do Insure Missouri if we’re not going to do some reform,” Mr. Jetton told the News-Press. “The governor’s concept is not a bad one. But what good is it going to do if we don’t bring the cost of health care down?”

Asked about the likelihood of him calling up the bill in the session’s remaining weeks, Mr. Jetton said, “It’s all up to the hospital association ... The bill’s on life-support — weak life-support.”

Opponents of including the CON reform accuse the House pair of raising the issue at an inappropriate point in the session.

Mr. Ervin said when House and Senate leaders met with representatives of the governor’s office to discuss Insure Missouri prior to legislation being drafted, hospital competition issues “didn’t get a warm reaction” and that “Dr. Schaaf never requested CON.”

“Basically, the House is breaking the deal with the governor and the Senate, and I don’t want any part in that,” Mr. Ervin said.

However, Dr. Schaaf said House majority caucus members submitted to Mr. Blunt a tentative framework for proceeding with Insure Missouri that included a CON reform or repeal before the governor postponed the March implementation.

“It shouldn’t come as any surprise,” Dr. Schaaf said. “We have stayed consistent in our position.”

However, a spokesman for the governor’s office claimed Mr. Jetton and Dr. Schaaf haven’t stressed CON until recent weeks. The News-Press on April 1 reported that Dr. Schaaf intended to roll CON reforms into Insure Missouri that were included in a bill from Rep. Timothy Flook, R-Liberty.

The governor “was obviously disappointed” to learn of this week’s funding cuts, said Rich Chrismer, a spokesman for Mr. Blunt.

“The governor supports CON reform. However, it’s too late to add such a big issue ...” Mr. Chrismer said. “The governor believes this issue is being used as an excuse by members of the House who don’t want to expand access to health care.”

Senate Majority Floor Leader Charlie Shields, R-St. Joseph, echoed the sentiments. Mr. Shields also is a marketing/communications officer for Heartland Health, which the hospital association represents.

“Clearly, they were not enthusiastic about Insure Missouri early on, and that’s probably showing up right now,” Mr. Shields said. “... I’ve never been clear how CON got attached to the issue. It was never part of the discussion we had in the governor’s office.”

Daniel Landon of the hospital association has said the reforms suggested in the bill would be identical to a repeal since virtually no applicant could be rejected. The reforms shift the burden of proof so that existing hospitals must show any competition is unnecessary.

“We made ourselves available to the hospital association to make the CON process more fair. I’m ready to negotiate and ready to find the common good,” Dr. Schaaf said. “That’s what we require to move on. It just depends on whether hospitals reverse their position.”

The association’s own Web site includes an endorsement of the Insure Missouri concept, but spokesman Dave Dillon indicated the group’s stance on CON is firm and that the group is mobilizing supporters to pressure House members to only pass a clean version of the bill.

The Senate voted up a clean version of Insure Missouri last week.

“I think anyone who thinks three weeks out the game is over is deceiving themselves. It’s way too early to write an epitaph,” Mr. Dillon said.

If neither side gives, however, the bill likely will fail.

“It would be a great shame if it did ... because of this game of chicken being played,” Mr. Dillon said.

Alyson E. Raletz can be reached at alysonraletz@npgco.com.