A local doctor whom voters re-elected to the Missouri House of Representatives could receive different attention from the Legislature’s new leadership.

With one of Rep. Dr. Rob Schaaf’s biggest supporters, House Speaker Rod Jetton, term-limited and stepping down, even the St. Joseph Republican said he is unsure of his future status as a committee chairman and what momentum his hospital competition advocacy will have in 2009.

“I don’t know,” Dr. Schaaf said several times.

The man who will lead the chamber next door sees a clearer picture.

“I would be shocked if he would be in the position again to hold health care hostage ... That’s very hard to do unless you’ve got the assistance of the speaker, as he did last year,” said Sen. Charlie Shields, R-St. Joseph, whom Republicans have chosen as the next president pro tem of the Senate.

Dr. Schaaf on election night dubbed his win over Democratic challenger Mark Sheehan as a mandate from voters to pursue issues surrounding competition in health care.

It was controversial competition issues that tripped up Gov. Matt Blunt’s Insure Missouri, a plan to broaden Medicaid eligibility that never came up for a vote in the 2008 legislative session. Dr. Schaaf chaired the healthcare transformation committee that considered the House’s version of Insure Missouri, which Dr. Schaaf also was co-handling.

To recap, Dr. Schaaf and Mr. Jetton, in a written agreement this spring, told the governor they would move ahead with Insure Missouri, as long as it included components that would increase hospital competition and transparency.

When those concepts hit the legislation itself, the Missouri Hospital Association fiercely lobbied against any Insure Missouri plan that contained changes to the state’s Certificate of Need program. All hospitals that wish to enter a Missouri market must undergo a stringent CON process before opening.

Mr. Jetton and Dr. Schaaf vowed to stop any Insure Missouri bill from receiving attention in the House if it didn’t include the changes they advocated, and the hospital association convinced enough legislators to reject their proposal. The hold-up drew ire from both political parties.

“Without Rod Jetton’s support, he would not have been able to handle the bill the way he did,” said then-Democratic caucus chairman Rep. Ed Wildberger, of St. Joseph. “The pressure from the governor’s office and the rest of the party would’ve forced him to bring the governor’s bill to the floor without adding all of the controversial (language).”

House Republicans have tapped Rep. Ron Richard, of Joplin, as the next speaker of the House. Efforts to contact him last week were unsuccessful.

“Ron Richard is an astute enough politician that he knows he’s going to have to compromise with the governor,” Mr. Wildberger said.

Mr. Shields noted that the relationship between Dr. Schaaf and Mr. Richard is different than the one with Mr. Jetton.

“Rep. Schaaf and Rod Jetton were very, very close,” Mr. Shields said. “Ron Richard is certainly respectful of Rep. Schaaf, but I’m not sure he has the same closeness.”

Mr. Shields said most health care discussion in 2009 will volley between the Legislature’s and new Gov. Jay Nixon’s opinions on how to increase coverage for Missourians.

“Rob likes to talk a lot about competition, but that doesn’t really address the coverage issue,” Mr. Shields said.

Daniel Landon of the Missouri Hospital Association, which openly attempted to unseat Dr. Schaaf through the backing of Mr. Sheehan during the campaign, said the group was prepared to continue to go the General Assembly and express its opposition to the repeal of certificate of need.

“It’s a little hard to tell if the conversation will be the same in 2009,” Mr. Landon said. “... Clearly Dr. Schaaf will have his legislation out there.”

With legislators set to begin filing bills Dec. 1, Dr. Schaaf said he’s now unsure if he’ll propose any legislation related to certificate of need, but he will file a bill that would allow patients to choose their own doctors without insurance limitations.

“I think the 10,000 people who voted for me want me to do that,” he said.

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