SS/SCS/SB 18 - This act creates a Universal Health Assurance Commission to allow the study of implementing a universal health assurance program for the purpose of providing a single, publicly financed statewide program to provide comprehensive, necessary health care services, including preventive screening, for all residents of the state. The commission shall have as one of its goals the immediate implementation of less restrictive income methodologies for the MO HealthNet elderly and permanently and totally disabled population, facilitating the inclusion of small employers in the state employee health care plan and the study of any other possible coverage expansions in the MO HealthNet populations while the establishment of universal health coverage is achieved. The commission shall submit annual reports with a plan and recommendations for such implementation. The Missouri Health Care Trust Fund is also created to allow for federal payments received as a result of any waiver from the Department of Health and Human Services to be used for implementing a universal health assurance program. This act also raises the income limit for eligibility for MO HealthNet services for the elderly and permanently and totally disabled populations from 85% of the federal poverty level to 100% of the federal poverty level. As to the permanently and totally disabled population, this act allows the Family Support division to exclude certain income or resources of a parent or parents in determining the applicant's eligibility for MO HealthNet benefits. The definition of "affordable employer-sponsored health care insurance" for health care for uninsured children (CHIP) program is also modified. It is now defined as health insurance requiring no monthly premiums for families with a gross income between 151 and 225% of the federal poverty level and no more than a 50 dollar a month premium for families with a gross income between 226% and 300% of the federal poverty level. This act also allows small employers to join the Missouri Consolidated Health Care Plan. For purposes of the act, the term small employer means an employer who employed an average of at least one but not more than fifty persons during the preceding calendar year and who employs at least one person on the first day of the plan year. A small employer includes a sole proprietor and a partner of a partnership. The state health care plan shall maintain a separate benefit trust fund account for premium payments and other income received from small employers. The small employer health care portion of the bill is identical to SB 741 (2008), SB 267 (2007), SB 593 (2006), SB 277 (2005) and HB 1412 (1998). ADRIANE CROUSE