House Passes Lottery Ticket Bill to Fund Veterans’ Homes

To provide a new funding source for veterans’ homes, cemeteries, and outreach programs in Missouri, the House of Representatives approved HJR 48 this week with a vote of 132 to 10.

Rep. Allen speaking on HJR 48.

This bill, which I co-sponsored, proposes a change to the Missouri Constitution that, if approved by voters, would require the State Lottery Commission to develop and sell a Veterans Lottery Ticket by July 2015. The funds raised through the sale of this ticket would be dedicated to the Veterans’ Commission Capital Improvement Trust Fund, which supports the seven veterans’ homes in our state.

Veterans’ homes currently provide services to 1,350 residents, but there are another 1,800 veterans in need of skilled nursing care that are waiting for admission because the homes have been chronically underfunded. With the money from the lottery ticket, more veterans will be able to obtain the support and services they need. This funding will also be allocated to veterans’ cemeteries and outreach efforts that help veterans access the benefits available to them.

We all owe the brave men and women who have defended our rights and freedoms an enormous debt of gratitude. As a legislature, we must do everything in our power to provide the funds necessary to support those who have laid their lives on the line.

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Breast Density Legislation: Improving Patient Information and Options

In the United States, one woman is diagnosed with breast cancer roughly every three minutes, and a woman dies from this disease every thirteen minutes. In the state of Missouri alone, there were 4,242 cases of breast cancer last year.

Rep. Allen with Patty Richard and Kathy Brown after the passage of HB 1510.

Unfortunately, mammograms, which are meant to detect breast cancer, may not be a sufficient screening tool for the 40% of women in the US with dense breast tissue. To provide women with adequate information on breast density, I sponsored House Bill 1510, which was voted out of the General Laws Committee with unanimous approval on February 5.

HB 1510 requires certified mammography facilities to provide patients with a notice stating that if they have dense breast tissue and other risk factors for breast cancer, they may benefit from supplemental screening tests. The bill does not mandate additional screenings but informs patients and encourages open communication with their doctors.

Breast tissue comes in two forms, fatty tissue, which is non-dense and appears as a dark spot on a mammogram, and connective tissue, which is dense and appears as a light spot on a mammogram. Since abnormalities and dense breast tissue both appear white on a mammogram, the mammogram may not always reveal the cancerous tissue. Conventional mammograms can detect 95% of cancers in fatty tissue but only 60% in dense breast tissue.

For women with dense breast tissue and an increased risk of breast cancer, additional screenings can be vital for early detection. Supplementing mammograms with an ultrasound can improve the detection rate dramatically for them, from 48% to 97%.

Doctors report that they only speak to 9% of women over 40 about dense breast tissue. A 2010 survey found that 95% of women did not know if they had dense tissue, and 90% of women did not know that dense breast tissue increases the risk of developing breast cancer.

Patients deserve to be fully informed about their risks for cancer and their options for screenings. HB 1510 will give women the information they need to make the best decisions possible about their health.

UPDATE: House Bill 1510 passed the Missouri House of Representatives by a vote of 146 to 6 on February 26, 2014 and will move to the Senate for consideration.

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Broadening Access to Life-Saving Cancer Medication

When cancer patients in Missouri are undergoing treatment, they deserve access to as many effective remedies as possible to give them the best chance for recovery. Due to insurance companies’ categorization of chemotherapy treatments, however, patients may face significantly higher out-of-pocket costs for oral chemotherapy medication.

While traditional chemotherapy is given intravenously, oral chemotherapy is taken in pill form. Doctors may prescribe oral chemotherapy for certain patients because it often has fewer side effects, including hair loss and nausea. Unfortunately, many patients are unable to fill their oral chemotherapy prescriptions because the monthly out-of-pocket cost can be thousands of dollars more.

House Bill 1327, which I co-sponsored, will rectify this disparity by requiring insurance plans that cover intravenous chemotherapies to also cover oral chemotherapies. The General Laws committee held a public hearing on this bill on Tuesday, February 4.

A recent actuarial study found that this change will not have any significant impact on the cost of premiums, but it will give Missourians fighting for their lives access to another treatment option.

Twenty-seven states and Washington DC have passed oral chemotherapy parity legislation since 2007. With broad bi-partisan support for this bill, I hope Missouri will become the next state to help cancer patients be able to afford to follow their doctors’ recommendations.

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Improving Missouri’s Child Welfare Services

As part of his fiscal year 2015 budget proposal, Governor Jay Nixon is seeking a $6 million increase for the Department of Social Service’s (DSS) Children’s Division.

With this request for resources and with the Children’s Division under the leadership of Tim Decker, the new division director, I am hopeful and expecting to see evidence of positive changes for our state’s children in foster care.

The department should be held responsible for explaining where this money will come from and what the funding is meant to accomplish. If the funds are appropriated, DSS will need to prove to the legislature and the people of Missouri that it has put the money to good use.

Throughout the summer and fall, the Interim Committee on Improving Government Responsiveness and Efficiency heard testimony on several unfortunate incidents where children were harmed after their families were investigated by the Children’s Division.

Lucas Webb, a four year old from Holt, Missouri, died of blunt force trauma to his abdomen in 2012 only five days after Children’s Division workers declared him safe in his home, and a grandfather spoke to the committee about his struggle to have his grandchildren removed from an unsafe home.

The Children’s Division is responsible for protecting some of Missouri’s most vulnerable children, those in foster care or being removed from their homes, and must be held responsible for effectively implementing the procedures needed to keep them safe.

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Demanding Accountability through Appropriations

The Appropriations- Health, Mental Health, and Social Services committee has asked departments to go through the new decision items (NDI) they have requested funding for over the past few years and explain what the initiatives were supposed to accomplish and whether or not they are serving their intended purposes.

As legislators appropriate funds for various initiatives, we need to know whether or not the programs have brought about any positive changes in wellbeing or behavior.

The Department of Social Services (DSS) generally measures outputs, or how much money goes to program recipients, rather than the outcomes of its programs. Making a program larger does not mean that it is providing services more effectively. As we move forward with hearings, we will continue to ask DSS to provide performance measures for its operations.

The committee has also begun to delve into the Governor’s budget proposal, which he outlined during the State of the State address.

At each Appropriations- Health, Mental Health, and Social Services hearing, there will be time set aside for members of the public to speak before the committee. Messages should be no longer than five minutes, but written materials are also accepted. Please email me at sue.allen@house.mo.gov if you are interested in testifying.

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Missouri Medicaid Forced to Operate under Obamacare Rules

In spite of the passage of two statewide ballot initiatives opposing the Affordable Care Act (ACA) and consistent opposition in the General Assembly to Medicaid expansion, Missouri’s Medicaid services are forced to operate under the ACA’s new eligibility standards.

The ACA requires states to modify their Medicaid income eligibility standards to be equivalent to the Modified Adjusted Gross Income (MAGI) standards.

In Missouri, this means that there will no longer be an asset test to determine if individuals are eligible for Medicaid and child support payments will not be counted toward their income. The income of stepparents, however, will now be considered.

Missourians have long resisted the federal overreach of the ACA. The 2010 Missouri Health Care Freedom ballot initiative, which aimed to block the federal mandate forcing people to buy health insurance, passed with over 70% of the vote. In 2012, more than 60% of Missourians voted for a referendum to prohibit the governor from establishing a healthcare exchange.

Despite the clear will of the people in Missouri, proponents of Medicaid expansion are trying to further entangle Missouri with the federal government’s poorly-run services and cumbersome regulations.

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Oral Parity: Increasing Access to Life-Saving Treatments

JEFFERSON CITY, MO— Representative Sue Allen (R-100) has co-sponsored legislation addressing the co-payment cost disparity between orally- and intravenously-administered chemotherapies.

Currently, cancer patients in Missouri can be forced to choose between the chemotherapy that is fully covered by their insurance and the chemotherapy that is best for their particular situation. House Bill 1327, sponsored by Representative Sheila Solon (R-31), would bring insurance coverage parity to both forms of chemotherapy by requiring plans to cover oral chemotherapy products if they already cover traditional chemotherapies.

In addition to House Bill 1327, Senators Munzlinger and Silvey proposed Senate Bills 663 and 668 respectively to require oral chemotherapy parity.

“When cancer patients are fighting for their lives, they should have access to every possible option for effective treatment,” Allen said. “If a doctor believes that an orally-administered chemotherapy drug will be better for a patient, or will have fewer debilitating side effects, that medication needs to be available and affordable for the individual.”

On January 14, Allen and the American Legislative Exchange Council organized an educational event for members of the General Assembly to discuss oral chemotherapy parity. Brian Rosen of the Leukemia and Lymphoma Society and Oklahoma State Senator Greg Treat discussed innovations in medication and Oklahoma’s experience passing oral parity legislation.

“It was encouraging to see so many representatives and senators at the oral parity event,” Allen said. “I look forward to working with them to ensure that live-saving medication, no matter how it is administered, is available to Missourians.”

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Starting Session with an Emphasis on Accountability

I hope you all had a safe and joyous New Year full of time with your family and friends.

The start of the new year provides us the opportunity to reflect on the successes and challenges of the previous year and make the changes necessary to strive for an even better year ahead. With the new year also came the start of the 2014 legislative session, which began January 8 at noon.

Over the interim, I chaired two committees tasked with delving into a variety of pressing issues and generating ideas for legislative solutions to improve the policies and operations of Missouri’s government. As session gets underway, I am preparing for the budget process and examining if any of these recommendations would be best implemented through changes to statute or departments’ appropriations.

The Appropriations – Health, Mental Health and Social Services Committee, which I chair, and the House Budget Committee will continue questioning executive agencies on many of the issues identified by the interim committees.

The Joint Interim Committee on St. Louis Metropolitan Statistical Area Governance and Taxation held hearings in the St. Louis area to hear from local officials and residents about their concerns with the region’s taxation system and government structures. Many citizens testified against what they believed to be the committee’s purpose, studying a merger between St. Louis City and County, but the committee clarified that this issue was not within its purview.

While discussions about a City-County merger surface every ten to fifteen years, this committee was created to commission an independent study on governance and taxation issues in the St. Louis region. Previous interim committees, which I was also asked to chair, identified a need for further research in these areas.

The committee fulfilled its mission as outlined in House Concurrent Resolution 25 by commissioning an independent study on St. Louis County’s sales tax pooling system, municipal service delivery, tax increment financing and the St. Louis Boundary Commission.

The study will be complete by mid-May, but the committee’s report, which has been submitted to the Speaker of the House and President Pro Tem of the Senate, contains a summary of the testimony presented at the hearings and recommendations from government officials and members of the public.

The Interim Committee on Improving Government Responsiveness and Efficiency was created to evaluate whether or not departments are effectively and efficiently meeting the needs of Missourians. After identifying problems with departments’ accountability and transparency, the committee developed recommendations to improve the responsiveness of our state government. These recommendations and summaries of the hearings have been submitted to the Speaker of the House in the committee’s report.

One of the committee’s primary concerns is that executive departments consistently fail to develop performance measures to validate the effectiveness of initiatives. When developing new programs, departments need to define the outcomes they will achieve and put measures in place to determine whether or not they meet these goals.

I travelled to Jefferson City on Monday to prepare for the first Appropriations – Health, Mental Health and Social Services hearing of the year, which was held on January 7. The departments under the committee’s purview were asked to present outcomes for their new programs from the past two years. As these departments request funding increases during the upcoming appropriations process, it is vital that we be able to determine which initiatives are providing reasonable returns on taxpayers’ investment. These discussions will continue at the committee’s next hearing on January 14.

The legislature will use the beginning of this new year and the 2014 session to take stock of the challenges our state faces and begin working toward solutions. By implementing the recommendations identified by the Interim Committee on Improving Government Responsiveness and Efficiency and demanding transparency from departments during the budget process, we can ensure that state agencies serve the people of Missouri more effectively and responsibly.

To view the General Assembly’s session schedule and a list of upcoming committee hearings, visit www.house.mo.gov. Our schedule has been adjusted to have technical sessions for the first and second readings of bills. You can find more information on this process here. Having technical rather than regular sessions saves taxpayers $16,000 a day. Every bit of savings helps the government serve Missourians more efficiently.

Friends and constituents wishing to visit our office in room 303 of the Capitol are welcome and encouraged to call 573-751-9765 to make an appointment.

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Nixon Abandons the Consensus Revenue Estimate Process

TOWN AND COUNTRY, Mo. – State Representative Sue Allen believes House Budget Chairman Rick Stream and Senate Appropriations Chairman Kurt Schaefer were right to refuse the governor’s fiscally irresponsible revenue projections. She fully endorses the realistic consensus revenue estimate (CRE) agreed to by the House and Senate.

“Demanding a higher consensus revenue estimate is a political ploy to increase funding for programs with money that Missouri does not actually have,” said Allen, R-Town and Country. “I support the agreement reached by Chairman Stream and Chairman Schaefer on this important issue.”

Members from the House and Senate met with the governor’s Office of Budget and Planning along with experts from the University of Missouri Economics Department on Dec. 4 and 5 to work toward a growth estimate for the remainder of the current fiscal year and the upcoming year that starts in July. While members of the governor’s staff initially agreed with the CRE figures discussed at those meetings, the governor’s office has since changed course and made demands that the estimates be increased to levels legislative leaders say cannot be supported by realistic economic projections.

“As chair of the Appropriations – Health, Mental Health, and Social Services committee, I know that the budget process requires an accurate projection of the state’s revenue,” Allen said. “We rely on the CRE to know how much money is available for programs that serve Missouri’s most vulnerable citizens. This committee will begin its oversight hearings on January 7, before the Governor releases his budget recommendations.”

The House and Senate have agreed to write the state operating budget using the numbers that had been originally agreed to by all parties. They include a 2.0 percent revised CRE for FY14 and a 4.2 percent CRE for FY2015.

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Funding a New Psychiatric Hospital in Fulton

Fulton State Hospital, built in 1851, houses Missouri’s only maximum security psychiatric facility and is the oldest state psychiatric hospital west of the Mississippi. Unfortunately, this facility has long been underfunded and is in such a state of disrepair that it poses safety threats to patients and staff.

Governor Jay Nixon recently announced that he is making $11 million available for planning and designing a new maximum and intermediate security psychiatric facility in Fulton. His fiscal year (FY) 2015 budget recommendations will include a plan to fund the remainder of the $211 million construction project through a bond issuance.

The legislature actually appropriated the $11 million for the new facility in the FY 2014 budget, and this funding was supposed to be available months ago. Unfortunately, this money was part of the $400 million Nixon withheld earlier this year to convince lawmakers to uphold his veto of a historic tax cut bill. I am encouraged, however, that the Governor has realized the need for a new facility and finally decided to release the appropriated funds.

The legislature has long recognized the need for a new psychiatric hospital in Fulton. Last February, members of the Appropriations – Health, Mental Health, and Social Services committee toured the crumbling facility, and we were appalled by the conditions. Machinery from the World War II era is still in use, and some buildings are left unused because they are beyond repair.  After this tour, I released a statement expressing my support for including the funds needed to construct the new facility in a bonding package.

The Fulton State Hospital provides critical services to Missourians with the greatest mental health needs, and I look forward to working with Governor Nixon to secure the funding for a new psychiatric hospital. By dedicating additional resources to mental health services, we can ensure that staff members have a safe work environment and are able to care for patients in a high-quality facility.

In an effort to minimize office expenses, I use the free version of WordPress.com to blog. Unfortunately, this means my office has no control over the content or placement of ads on this site. Thank you for understanding.