Legislative reform aimed at increasing hospital competition could trip up Gov. Matt Blunt’s Insure Missouri plan to expand Medicaid eligibility.

Rep. Dr. Rob Schaaf, R-St. Joseph, author of legislation that would enact Insure Missouri in the House of Representatives contains a controversial piece that affects the state’s Certificate of Need program.

Any hospital wishing to enter a market must go through CON in order to set up shop.

Dr. Schaaf and other opponents contend the program costs too much for applicants and stifles competitions. Reforms include changes to the committee that oversees the program.

Representatives of the Missouri Hospital Association, which represents Heartland Health, have emphatically opposed changes to CON during committee hearings on the legislation.

The Senate, however, this week passed out a clean version of Insure Missouri without any CON components.

House leaders have indicated they will not bring an Insure Missouri bill to the floor for debate without CON.

Dr. Schaaf said he’s been assured that the Senate’s version will come to the healthcare transformation committee he chairs and the committee will just substitute its own language.

Theoretically, the two sides would work out the differences during conference negotiations.

“But we might not have a bill to conference,” Dr. Schaaf told the News-Press Thursday. “… This is keeping it from getting to the floor.”

Legislators say the Missouri Hospital Association has been lobbying heavily against CON, however.

The association must be gaining ground because Dr. Schaaf said the bill’s movement has come to a halt because the speaker won’t bring it to the floor unless he knows it has enough support.

Sen. Charlie Shields, R-St. Joseph, who Heartland employs as a marketing director, said he doesn’t believe the association and House members will come to an agreement in the three remaining weeks of the session and Insure Missouri’s ultimate chances of passage are questionable.

“They’re both very legitimate issues, but separate issues. I think it’s frustrating you’d kill Insure Missouri over a very separate issue,” Mr. Shields told the News-Press.