On the eve of arguments before the Supreme Court on the Affordable Care Act, local faith-based and community groups urged the state legislature to end "partisan sparring and gridlock" that is stalling key parts of the health-reform law in Missouri.

Nearly 200 people turned out for the meeting Sunday, which marked the second anniversary of the Affordable Care Act, at Congregation Shaare Emeth in Creve Coeur.  State Democratic and Republican leaders from the area were invited to the event, described by one sponsor as a nonpartisan discussion about "how we can create a situation where legislators understand values that brought us here today." No Republicans attended.

The legislature's decision to sit on more than $20 million in federal funding for setting up an insurance exchange system, and $50 million in federal money to upgrade the state's computer system to process Medicaid claims more efficiently, was discussed. That's an important issue because Medicaid would be significantly expanded to insure many Missourians if the health-reform law is upheld by the Supreme Court.

Federal and some state officials have said the exchange system is also important because it will allow consumers to use the internet to compare and buy health insurance with the same ease that they might purchase an airline ticket or reserve a hotel room. States have the option of setting up exchanges or using a model designed by the federal government. States are supposed to have their exchanges ready for federal approval by 2013 and up and running by 2014. But the federal government says it will be flexible about these deadlines.

"This is probably the most frustrating thing I've ever done since I've been in the Senate," commented Sen. Joe Keaveny, D-St. Louis, on Sunday as he discussed the refusal of the GOP-dominated legislature either to set up the exchange or go forward with upgrading the state's computer system.

Keaveny also told the audience that the meeting amounted to "preaching to the choir." Rather than talking to legislators who support health reform, he and other lawmakers urged participants to engage politicians and voters who support Missouri's inaction.

Nearly two years ago, Missouri voters overwhelmingly approved a state referendum against the law's provision requiring people to buy health insurance or be penalized.

The Democratic leadership argued that the vote was lopsided beacuse of a low turnout. They contended that the referendum would be meaningless because the federal mandate, if upheld by the courts, would prevail over Missouri's vote.

The referendum against the individual mandate seemed to have set the tone for GOP opposition to health reform in Missouri. The Republican leadership in Jefferson City has thwarted the Nixon administration from setting up an exchange and seemed cool to the idea of accepting federal dollars to upgrade state computers. The leadership has argued that it should wait until the Supreme Court rules on the Affordable Care Act this summer before deciding whether Missouri should set up an exchange.

On divisive health reform matters, Republicans also have taken their cue from Sen. Scott Rupp, R-Wentzville, who chaired a special committee that held hearings across the state last year to get public reaction to setting up an exchange. He also chairs the Small Business, Industry and Insurance Committee, which has jurisdiction over any exchange legislation introduced in the Senate.

Contrary to Democrats, he has insisted that Missouri still has time to act on an exchange, pointing to the fact that the federal government has eased some of its deadlines. Health and Human Services Secretary Kathleen Sebelius said recently that the change would "give states the flexibility they need to design an exchange that works for them."

But Rupp said, "The federal government has always pushed back all these supposedly hard deadlines. So that threat of you have to have it done by this date has pretty much fallen on deaf ears."  He added that Missouri and many other states were "on a holding pattern" until the Supreme Court handed down a ruling, expected in June. Once the Affordable Care Act is clarified, Rupp says Missouri will then decide what to do about the exchange issue.

That position is presumably among the reasons the Nixon administration has refused so far to comment publicly on the exchange or to push for money for upgrading the computer system.  At least one quasi-governmental group, the Medicaid Oversight Committee, has urged the state not only to create an exchange but draw down federal dollars to upgrade the computer system.  Consisting mainly of health professionals, academics and providers, the panel was set up during the Blunt administration to revise and update Missouri's Medicaid program.

Commenting on lawmakers' reasons for taking no action on the exchange and computer upgrades, state Rep. Jeanette Mott Oxford of St. Louis said at Sunday's meeting: "I've heard it all. It's pitiful. Shame on us. Apparently (there is a) lack of political courage on both sides of the aisle."

Other lawmakers urged the audience not to give up, saying that not all Republicans are against the law, adding that more needed to be done to change the minds of Democratic and Republican politicians and neighbors who are.

State Rep. Susan Carlson, D-University City, said state lawmakers were being shortsighted in rejecting the federal assistance. She said the $50 million would be used solely "to get the computer system up to speed. It didn't mean we'd put the Affordable Care Act in effect." She urged the audience to target the lawmakers. "Call them, call them, call them," she said, to show disappointment over "holding up this important legislation."

State Rep. Rory Ellinger, D-University City, pointed to arguments that the focus needs to be on issues such as the deficit rather than health care. He said voters needed to let the lawmakers know "that's my money you are talking about. I don't want to spend it that way. I want it spent on health-care needs."

Other state lawmakers attending were Independent Tracy McCreery of Olivette, state Sens. Robin Wright-Jones, D-St. Louis, and Maria Chappelle-Nadal, D-University City; and state Reps. Stacey Newman, D-Richmond Heights, and Jill Schupp. D-Creve Coeur.

Before the legislators spoke, several people told of their own experiences or that of family members in trying to get or keep affordable health insurance.

One was Erica Douglas, daughter of Robert Douglas, a Post-Dispatch retiree who died recently. The family has said his diabetic condition was exacerbated because he could not afford health insurance that would have helped him buy insulin.

"If Missouri had a health insurance exchange, my father might have been able to afford to continue his health care when the company ended" it, the daughter said. "But those exchanges didn't exist in time to help my dad, and he died."

She added, "Some people think that no one goes without health care in this country. But that's not true. My dad was an example of that."

Speaking as a leader of Paraquad and the Disability Coalition on Health Care Reform, Megan Burke told the audience the General Assembly was "embroiled in politics which is very frustrating to watch" at a time when the state should be gearing up for health reforms. "We want our elected officials to do what is best for Missourians by setting up a health-insurance exchange as soon as possible."

The Rev. Mark Harvey of Harmony United Methodist Church in Overland said an exchange would help not only individuals and families but also "small businesses, small nonprofits and small congregations to purchase quality health insurance that is easy to understand and fairly priced." He said, "Most congregations are having a pretty tough time providing health insurance for our own employees, let alone the thousands of uninsured people in our communities."

Farilyn Hale of the National Council of Jewish Women - St. Louis Section, said Missouri was only one of three states -- along with Georgia and Montana -- with little transparency in the way insurance companies operate.  She says insurers doing business in Missouri should be required to make their rate filings public and that Missouri needed authority to review and approve proposed rate hikes. She suggested that's one reason health insurance in Missouri grew 83 percent between 2000 and 2009 while median earnings grew only 23 percent. "We  all know people who have been personally affected by these skyrocketing costs," she said.

Leslie Caplan, a free-lance musician, told the audience that the absence of an insurance exchange was especially harmful in her case, as a divorcee who has to buy her own health insurance. If Missouri had an insurance exchange, she said she "would not be turned down for my 'pre-existing condition,' nor be expected to pay outrageous monthly premiums running into the thousands of dollars if I could get health insurance at all."

Sue Bohm of Chesterfield told the audience that health insurance cost was a factor that hurt what had been a "very successful retail business" run by her family. She said the family company had provided health insurance to workers, but that the company found it difficult to compete against larger chains. She told state lawmakers that creation of an exchange would mark a major improvement for businesses and families like hers.

"Someone needs to stop the abuses of the insurance agencies. If not you, then who?"