Missouri Under the Affordable Care Act: Where Are We? | St. Louis Public Radio

Missouri Under the Affordable Care Act: Where Are We?

Nov 14, 2014

On Saturday, open enrollment season for Healthcare.gov begins. For the second time around, public health organizations and insurance "navigators" are holding outreach events, running ads, and looking for the remaining uninsured Missouri residents.

Dara Taylor of Community Catalyst trains insurance navigators in the St. Louis area.
Credit Durrie Bouscaren / St. Louis Public Radio

But who are those uninsured Missourians? And how have the changes implemented through the Affordable Care Act affected the state?  

Hundreds of thousands of people in Missouri are uninsured. Who are they?

Last year, 152,335 people bought Missouri health insurance plans on the federal exchange -- about 57 percent of those eligible. Exact numbers for how many people remain uninsured in the state are not yet available, but the Census estimates that Missouri had about 773,000 uninsured people before the exchanges  became available.

Illinois had a similar rate: about 59 percent of those eligible. In Illinois, an additional 181,070 people were eligible for CHIP or Medicaid, which was expanded for low-income adults in the state.

Census numbers this year showed that before the exchanges were were available, 13 percent of Missourians were uninsured, a little below the national average of 14.5 percent.  

Credit Kaiser Family Foundation.

A survey by the Kaiser Family Foundation estimated that 62 percent of uninsured families in Missouri had at least one family member who worked but did not receive coverage from their employer.

With no expansion of Medicaid, nonprofits pick up the slack

Missouri has one of the lowest thresholds in the country for Medicaid coverage for adults. A single parent who is not blind, disabled or pregnant would have to make less than $7.76 a day to qualify for Medicaid coverage, and Medicaid does not cover nonelderly adults without children.

Because the Missouri legislature did not expand Medicaid under the Affordable Care Act, about 23 percent of uninsured residents fall into a so-called "coverage gap": They make too much to qualify for Medicaid but too but too little to qualify for income-based subsides to buy coverage on Healthcare.gov, the federal exchange for individual plans.

In the St. Louis area, public health nonprofits like Gateway to Better Health have covered doctor’s fees for people who live below the poverty line and do not have insurance through an employer, Medicare or CHIP.

But Rob Fruend of the St. Louis Regional Health Commission said it’s not a permanent fix.

“We don’t cover inpatient [hospital services], we don’t cover mental health. We’re on a limited budget,” Fruend said. “That’s why we really hope we get Medicaid expansion before Gateway gives out.”

The federal government extended a $25 million grant to Gateway to Better Health to keep the program operating through 2015. But the payments come from Medicare’s "disproportionate share hospital" payments, so the amount of funding available for those grants will continue to decrease over the next five years.

For people seeking individual insurance, some prices increased

Open enrollment season for the federal exchanges runs from Nov. 15 to Feb. 15. For coverage to begin on the first day of the new year, the deadline for enrollment is Dec. 15.

St. Louis residents looking for individual plans can choose from more than 40 options offered by four different carriers. On the Illinois exchange, residents of the metro east will see about 39 plans from four insurance companies. Many consumers can receive tax subsidies to purchase insurance, which are based on income. Small business owners will also be able to purchase plans for themselves and their employees.

In Missouri, two additional insurance carriers entered the market, almost doubling the number of plans available.

“That’s good. More plans increase competition; more plans increase choice. People who want to use the marketplace should see an in-person assister because there are lots of choices to make and it helps to have an expert,” said St. Louis University law professor Sidney Watson.

Watson also warned that some plans may have changed for people who purchased coverage on the exchange last year so they should check to be sure their plan still fits their needs. If they take no action, they’ll be automatically re-enrolled in their current plan.

Watson and her students took a look at the latest premium costs for insurance plans on the Missouri exchange.

For a 40-year-old non-smoker earning $30,000 a year, the price of a medium-cost silver plan’s premium decreased by about 2 percent on average. But there were significant variances in pricing among metro areas -- ranging from an increase of more than 16 percent in Hannibal to a decrease of 14.3 percent in Springfield.

Prices increased on the lowest cost plans. The SLU analysts calculated the average premium of the lowest cost bronze plan for a 40-year-old nonsmoker with a $30,000 income: After subsidies were factored in, those plans increased about 20.4 percent on average.

With some exceptions, 2015 is the first year that people will pay penalties on their federal tax returns for not having insurance in 2014. The charge is one of two calculations, whichever is higher: $95 a person in the household (less for children, and no more than $285 total), or 1 percent of a household’s yearly income.

The penalty for not purchasing insurance also increases this year — to 2 percent of a household’s yearly income or $325 a person (less for children and no more than $975 total), whichever is higher.

Nationally, 71 percent of people who purchased plans on the federal exchanges said they liked their insurance, rating their coverage "excellent" or "good," according to a Gallup poll released Friday.