Affordable Care Act | St. Louis Public Radio

Affordable Care Act

On Thursday, U.S. Sens. Tammy Duckworth, D-Ill., Roy Blunt, R-Mo., Claire McCaskill, D-Mo., and Dick Durbin, D-Ill., cast late night votes for and against the most recent health care bill making rounds on Capitol Hill.
Ryan Delaney, Gage Skidmore, Center for American Progress

After another Republican Senate loss early Friday, Missouri and Illinois senators are calling for a return to bipartisan talks to overhaul the nation’s health care law.

They include U.S. Sen. Roy Blunt, a Missouri Republican, who had tried to help his party’s leaders come up with the votes needed for a trimmed-back version of a bill that would have repealed key provisions of the Affordable Care Act, the signature achievement of former President Barack Obama.

Lacy Seward, social services coordinator for the Monroe City Manor. Medicaid cuts proposed by Senate Republicans could hit hard in this small town, that helped vote them into office.
Durrie Bouscaren | St. Louis Public Radio.

MONROE CITY, MO. — The closest emergency room is 20 miles east on the highway. That’s why it isn’t unusual for people experiencing heart attacks, blood clots and strokes to show up at Dr. Rodney Yager’s clinic on Main Street in Monroe City.

Yager, who grew up in the area, can handle the fast pace of a small-town clinic. What worries him more is how federal health care policies being shaped in Washington, D.C., could affect his patients.

For sickle cell patients, opiods are often the only pain relief. But growing rates of addiction among the general public mean emergency room doctors are more cautious than ever in prescribing those powerful medications, causing challenges for sickle cell
Carolina Hidalgo | St. Louis Public Radio

Anthem Blue Cross Blue Shield, one of Missouri’s largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Centene Corp. will step into the breach created by Blue Cross and Blue Shield of Kansas City’s decision last month to exit the Affordable Care Act marketplace in 2018.

The Clayton, Mo.-based insurer will begin selling health plans next year in all 25 western Missouri counties that Blue KC’s withdrawal would have left “bare” — that is, without any insurer offering health plans in the individual market. 

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Supporters of the Affordable Care Act rallied in front of the White House in late February 2017
Ted Eytan | Flickr

The nonpartisan Congressional Budget Office weighed in on the Senate health care bill on Monday, saying that 22 million people would lose health coverage in the next 10 years under the Senate's plan. Of those, 15 million would lose Medicaid coverage. It's projected to lower the deficit by billions over 10 years, and also cut taxes on corporations and the wealthy.

Rici Hoffarth | St. Louis Public Radio

Updated June 27 with a new timeline:

Republicans in the U.S. Senate said Tuesday they would delay a vote to pass their plan to replace the Affordable Care Act.

The Senate's Better Care Reconciliation Act would reduce the federal deficit by $321 billion and leave 22 million more people uninsured by 2026, according to Monday’s estimate by the Congressional Budget Office. Like the House plan, it slashes Medicaid and allows states to redefine what’s covered in a basic health insurance plan, in a bid to lower costs.

Susannah Lohr | St. Louis Public Radio

Next year, Blue Cross Blue Shield of Kansas City will leave the individual health care marketplace in Missouri that was set up under the Affordable Care Act. And when it does, about 18,000 patients in 25 western Missouri counties will lose their health insurance. If those enrollees sign on to Healthcare.gov this fall to buy a replacement plan, they may have no options to choose from.

That's because those 25 counties could become "bare."

Three weeks after Blue Cross and Blue Shield of Kansas City said it will pull out of the Affordable Care Act exchange in 2018, Centene Corp. says it plans to offer coverage through the exchange in Missouri and Kansas.

The St. Louis-based insurer already has a presence in both states administering Medicaid plans, but the move to sell individual and small group health plans is new.

For the hundreds of rural hospitals struggling to stay in business, health policy decisions made in Washington D.C. this summer could make survival a lot tougher.

David Mueller, 31, picks up his three-year-old daughter Marjorie from daycare on May 4, 2017. She has a rare form of cystic fibrosis, and Mueller worries the Republican health plan will affect the family's ability to pay for her care.
Durrie Bouscaren | St. Louis Public Radio.

A Republican proposal to gut the Affordable Care Act narrowly passed the U.S. House of Representatives and now the U.S. Senate is crafting its own bill to reshape the nation’s health care system. Elected officials have held few town halls to hear from constituents in the St. Louis area about what they want in a health care bill, sparking demonstrations outside representatives’ offices.

Barb Fleming of Bel-Nor enrolled in Missouri's high-risk pool after a breast cancer diagnosis in 2008. Today, she pays much less for a plan through the Affordable Care Act.
Durrie Bouscaren | St. Louis Public Radio.

Barb Fleming had built a small business selling tableware and wedding gifts. But that career nearly came crashing down around her in 2008, when her doctor found a lump in her breast. 

Months later, Fleming, of Bel-Nor, in St. Louis County, would find herself in Missouri's high-risk pool: a pricey, state-managed insurance plan that covered people with pre-existing conditions. The programs were phased out by the Affordable Care Act, but could return in the sweeping health care proposal passed this month by House Republicans.

Sen. Claire McCaskill in May 2017
Provided | Office of Senator Claire McCaskill

U.S. Sen. Claire McCaskill said Thursday she thinks it’s important for Congress to “repair, not repeal” the federal Affordable Care Act, which she says is under threat by the Trump administration’s hints that it won’t continue to pay subsidies to participating insurance companies.

About 40 counties in Missouri have only one insurer participating in the Affordable Care Act’s insurance marketplace.

File photo | Chris McDaniel | St. Louis Public Radio

U.S. Sen. Roy Blunt for years wasn’t shy about his disdain for the Affordable Care Act, condemning it on the Senate floor, in town hall meetings and during interviews.

Then came Tuesday, when the Republican said fixing President Barack Obama’s signature health-care law doesn’t hinge on whether Congress takes action this week to do away with it entirely.

In the current debates over health care, one topic rarely gets mentioned: dental health benefits. That’s because dental health has historically been separated from the rest of medicine. But today, that separation leaves many Americans with no way to prevent or treat debilitating dental health problems.

Author Mary Otto tells the story of the rampant disparities in dental health in the United States and how those play into other disparities of race, class and income in her new book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.


Six years ago, 53-year-old Corla Morgan noticed blisters forming on her neck and back.

“I couldn’t sleep because when I took my shirt off, if my shirt touched my skin, the skin just peeled off,” Morgan says. “I was in really horrible pain.”

Tax season is underway. So is a program that helps low- to moderate-income St. Louis families prepare their taxes for free.
401(K) 2012, via Flickr

Here’s something that may need to be clarified this tax season. Despite the ongoing debate in Washington over a repeal of the Affordable Care Act, the law’s requirement for people to be enrolled in health coverage or face a tax penalty is still on the books.

“People should go ahead and take care of their taxes as they would, as if the law hasn’t changed," said Geoff Oliver, a staff attorney for Legal Services of Eastern Missouri. "Because at this point the law hasn’t changed.”

Rici Hoffarth | St. Louis Public Radio

On Monday, St. Louis on the Air’s monthly legal roundtable returned to address pressing issues of the law with a panel of local legal experts. This month’s focus? The proposed replacement for the Affordable Care Act.

St. Louis Public Radio’s Durrie Bouscaren has been reporting extensively on this matter and its local impact. Here’s how Missouri fares in cost estimates for the GOP’s health care plan.

Van Tyler checks a list of names and addresses while delivering meals in Jennings for the Mid-East Area Agency on Aging in June, 2016.
File photo | Durrie Bouscaren | St. Louis Public Radio

States with rapidly aging populations, like Missouri, are seeing increased costs to Medicaid programs that cover low-income residents.

But the Republicans' health care proposal to replace the Affordable Care Act would create per-capita caps for federal Medicaid funding, potentially shifting increased costs to states. Advocacy groups for seniors warn that the proposal working its way through Congress may not adequately fund their care.

Rici Hoffarth | St. Louis Public Radio

The Republican plan to replace major tenets of the Affordable Care Act would reduce the federal deficit by $337 billion over 10 years, according to new numbers from the nonpartisan Congressional Budget Office.

In that scenario, 24 million people would lose their health insurance, bringing the uninsured rate back up to nearly what it was before the Affordable Care Act. The White House has disputed these numbers.

Susannah Lohr | St. Louis Public Radio

If House Republicans pass their proposed replacement plan for the Affordable Care Act, state Medicaid programs would face some big changes, including a per-capita cap on spending.

Republicans introduced their plan Monday in the form of two budget reconciliation bills. Though the bills repeal several taxes that helped pay for the Affordable Care Act, they were sent into markup sessions before a cost estimate could be prepared by the Congressional Budget Office.

Adrian Clark | Flickr

Missouri legislators are considering a measure that would allow the state to fold into a proposal that has become a popular GOP refrain: Convert funding for state Medicaid programs into block grants.

When Joe Morris had a heart attack last Easter and had to be rushed to the ER, it was the first time he’d been to the doctor in more than 40 years — since high school.

Back home in the small community of Neosho, Mo., Morris needed follow-up care to manage his heart disease and diabetes, but he didn’t have a doctor — or insurance.


Alycia Wilson with her husband and daughter in Edwardsville, a few days after the election. Wilson, a Trump voter, said she hopes for a repeal of the Affordable Care Act.
File photo | Durrie Bouscaren | St. Louis Public Radio

Republicans in Congress and President Donald Trump have their eyes trained on the Affordable Care Act, which they plan to dismantle.

How they do so, and when, may affect health coverage for millions of Americans. A dramatic shift in policy could reverberate through hospitals, insurance markets and the rest of the health-care industry. At this point, say health law experts, the only thing that's certain is more uncertainty.

The St. Louis Children's Hospital's logo, which replaces the 'n' in 'Children's' with an image of the Gateway Arch, is printed all over the hospital campus, including the entrance off Kingshighway Boulevard. Spokeswoman Abby Wuellner said the logo represe
File photo|Nassim Benchaabane | St. Louis Public Radio

Missouri hospitals are providing less charity care than they did before the Affordable Care Act, according to a report by the Missouri Hospital Association.

But that's not necessarily a sign that hospitals are being stingy. According to the report's authors, that means more people can pay their medical bills.

It’s indicative of more people having insurance,” said Dave Dillon, spokesperson for the MHA. “The numbers for 2015 show very good progress.”

Valéria Souza, 36, hugs her step-daughter in a family photo.
provided by Valéria Souza

Three in 10 Missouri adults could have difficulty purchasing their own health insurance if the Affordable Care Act the next Congress fully repeals the Affordable Care Act. That’s because one of the act’s main provisions requires insurance companies to cover individuals with pre-existing conditions — a definition that once included pregnant women, cancer patients in remission and people with such common medical issues as obesity.  

The figures come from an analysis by the Kaiser Family Foundation, which determined that about 27 percent of American adults under the age of 65 would qualify as having a pre-existing medical condition. In Missouri, the rate is slightly higher.

Tony Twitty, 55, founded his auto shop in 1999. Before the Affordable Care Act,it was hard for him to buy health insurance on his own.
Durrie Bouscaren | St. Louis Public Radio

After running on a platform that included calls to repeal the Affordable Care Act, president-elect Donald Trump will take office alongside a Republican-controlled Congress in January. This leaves an estimated 20 million people who gained coverage through the law unsure of how their coverage will change.

In the weeks since the election, the general consensus among health law experts is that it’s unlikely that congressional Republicans will repeal the law entirely without a plan to replace it, particularly because Senate Democrats have enough seats to filibuster.

Last week’s election results stunned a lot of people who get health insurance coverage through the Affordable Care Act.

President-elect Donald Trump and the Republican-controlled Congress say they want to scrap the law, but what might replace it remains unknown.

That has left many Missouri and Kansas families in limbo, unsure what will become of their medical care.

Mike Cluck stands with his wife, Nancy, in the front hallway of their home in Edwardsville.  (Nov. 10, 2016)
Durrie Bouscaren | St. Louis Public Radio

An estimated 20 million people have health insurance through the Affordable Care Act, but dissatisfaction with the law helped propel Donald Trump the presidency. 

One criticism is a lack of choice for insurance plans bought on Healthcare.gov, an online marketplace established for uninsured individuals to shop for coverage. In three Illinois counties east of St. Louis, residents have just one insurance provider to choose from on the exchange for 2017, and enrollees say the coverage appears to have some serious gaps.

Sidney Watson, a SLU law professor and local expert on the Affordable Care Act, answered questions about health insurance premium increases in Missouri on Friday.
Kelly Moffitt | St. Louis Public Radio

By now, you’ve likely heard the headlines, news bites and chatter around the dinner table: the prices for many individual Affordable Care Act health plans are going way up across the country. Here’s a good summary of what is happening nationwide.

Angela Merten is an in-person assister for the federal online marketplace at Touchette Regional Hospital. But she says most of the people she'll help sign up for health insurance will qualify for Medicaid under Illinois' expanded program.
File photo |St. Louis Public Radio

The eastern St. Louis metro area has been particularly hard hit by health insurance companies exiting the Affordable Care Act exchange. This week, the federal government released prices for 2017, which include substantial increases in western Illinois.

Insurance brokers in Belleville say three Metro East counties — St. Clair, Madison and Monroe — will have just one insurer to choose from this year: Blue Cross Blue Shield.

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