Affordable Care Act

Tim Greaney and Sidney Watson, law professors at Saint Louis University, joined "St. Louis on the Air" to discuss the Aetna pull-out's impact on the Affordable Care Act.
Kelly Moffitt | St. Louis Public Radio

This week, health care company Aetna (in Missouri: Coventry) announced it would pull out from Missouri’s Affordable Care Act health exchange next year, leaving Missouri residents fewer choices for health insurance. On Friday’s “Behind the Headlines,” St. Louis on the Air will take a look at the background behind this decision, how it impacts people in our region, and the implications for the future of the ACA.

Keith Carter, 53, waits to pick up a prescription for diabetes at Affinia Healthcare in St. Louis. Though he falls in the income gap, he's able to get his preventive care covered through Gateway to Better Health.
Durrie Bouscaren | St. Louis Public Radio

At any given time, a half dozen people sit in the waiting room at Affinia Healthcare in south St. Louis. Two parents coo over a new baby, while a group of older patients chat along the back wall.

53-year-old Keith Carter sits alone. An embroidered polo shirt and badge show he’s just come from work.

“I seem fit. Inside, it’s just breaking down like sawdust. I just keep it in motion,” he said, as he waited to pick up a prescription to manage his diabetes.

Gustavo Valdez, an insurance navigator with the Community Action Agency of St. Louis County helps Charles Niemeyer enroll in health insurance through the website.
Camille Phillips | St. Louis Public Radio | File photo

The U.S. Department of Health and Human Services says it is trying new ways to market health insurance to uninsured millennials.

In a press conference Tuesday, officials announced several strategies to target young, healthy adults to balance the risk pool of the Affordable Care Act marketplace.

Adrian Clark | Flickr

Legislators are scheduled to meet Thursday to consider a bill that would give Missouri’s regulating agency for insurers the chance to review health insurance rates before they affect consumers who use —and allow them to object if prices are about to jump too high.  

s_falkow | Flickr

The past year was a landmark one for many legal issues—both nationally and locally. On Thursday’s “St. Louis on the Air,” our monthly Legal Roundtable convened to discuss the legal decisions (or lack thereof) which had the most impact on 2015. They also looked ahead to 2016.

Joining the show:

After a chance meeting, Katie Eisenbeis (right) schedules a future appointment for one of her patients in the mobile health program.
Durrie Bouscaren | St. Louis Public Radio

When the Affordable Care Act went into effect, many health-care economists hoped it would reduce the number of emergency room visits made by uninsured people. The idea was that if more people had health insurance, they would be more likely to have access to a primary care doctor and avoid the emergency room.

Kelly Moffitt | St. Louis Public Radio

According to Saint Louis University Health Law Policy Center Professor Sidney Watson, there are two big dates you need to take note of for Affordable Care Act coverage:

  1. Dec. 15, 2015: The deadline to enroll in Affordable Care Act health insurance coverage in order for it to be active on January 1, 2016.
  2. Jan. 31, 2016: The deadline for the year to enroll in Affordable Care Act health insurance coverage in order for it to be active on March 1, 2016. Open enrollment won’t be available again until November 2016. 

Dean Puckett (left), a federal navigator, and Ashlei Howard, a certified application counselor, sit in their new offices at the St. Louis Effort for AIDS just two days before the start of open enrollment season.
Durrie Bouscaren | St. Louis Public Radio

As the third year of gets underway, an estimated 90,000 people in the St. Louis region are still uninsured and eligible to buy health insurance on the federal marketplace, according to the Centers for Medicaid and Medicare Services. 

Effort for AIDS counselors like Sade Singleton have spent the past few months leading up to enrollment doing outreach and health literacy presentations throughout the region. Last year, the nonprofit helped about 700 people sign up for health insurance in St. Louis. 

Pearl Holden portrait
Durrie Bouscaren | St. Louis Public Radio

Adrienne Holden has seen hard deaths and easier deaths. Long ones and short ones. Times when the deceased left their families with precise instructions for their care and burial, and times when they did not.

(via Flickr/steakpinball)

The U.S. Supreme Court recently passed monumental decisions on same-sex marriage and upheld a high-profile challenge to the Affordable Care Act.

File photo of Mercy Hospital in St. Louis.
Durrie Bouscaren | St. Louis Public Radio

Updated at 10:25 am June 25, 2015 with details of St. Louis area job cuts and comment from Mercy Health President and CEO 

Mercy Health says it has eliminated 126 positions in the St. Louis area.

The reductions are part of a previous announcement to cut nearly 350 jobs system-wide.

The Chesterfield-based health care provider has operations in several states including Missouri, Arkansas, Oklahoma and Kansas.

Protesters holding sign in front of Supreme Court
LaDawna Howard | Flickr

In a 6-3 decision, the Supreme Court upheld a high-profile challenge to the Affordable Care Act that could have made health insurance unaffordable for more than 5 million people.

Updated at 1 p.m. ET

The U.S. Supreme Court on Thursday handed the Obama administration a major victory on health care, ruling 6-3 that nationwide subsidies called for in the Affordable Care Act are legal.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," the court's majority said in the opinion, which was written by Chief Justice John Roberts. But they acknowledged that "petitioners' arguments about the plain meaning ... are strong."

Adrian Clark | Flickr

2016 will be the third year that Missouri goes without Medicaid expansion, as Republicans have stayed firmly against it in the General Assembly.

Connie Chapman, who worked at the Sac-Osage Hospital in Osceola, Mo.,for 40 years, looks over a nearly empty room in the hospital.
Todd Feeback|Heartland Health Monitor

Chris Smiley spent most of Tuesday moving the last of the boxes out of Sac Osage Hospital in rural Osceola, MO. In the months after the small town’s only hospital closed for good, the facility’s CEO has been selling off supplies and making arrangements to transition her patients’ care to other places. The building itself is set to be demolished.

“We arranged to have another facility take over our clinic,” Smiley said. “There will be ambulance service in the community. There’s a heli-pad that will be maintained by the ambulance bay.”

Adrian Clark | Flickr

Hospitals are pushing for Medicaid expansion in Missouri. Physicians say it’s crucial. And yet, lawmakers in favor of expansion have been unable to offer a proposal that the legislature’s Republican majority will accept. 

Adrian Clark | Flickr

The numbers are in: 253,969 people in Missouri signed up for health insurance on this year, or were automatically re-enrolled in their plan. That’s about 100,000 more than last year’s open enrollment period.

Adrian Clark | Flickr

Administrators for Missouri’s Medicaid program told members of their oversight committee that they are getting closer to fixing their processing delays for new applicants. But the wait can still take months.  

“We are now under 13,000 pending applications. I think we will get into that normal, historical range within the next week,” said Family Support Division Director Alyson Campbell at an oversight committee meeting of MO HealthNet, the social services division that administers Medicaid in Missouri.   

Rachel Bingham, a single mother, earns too much to qualify for Medicaid, but too little to afford health insurance for herself and her daughter.
Durrie Bouscaren | St. Louis Public Radio

While rolling silverware at the City Diner in St. Louis, waitress Rachel Bingham recalled her attempt to buy health insurance for herself and her five-year-old daughter last year. She said when she signed on to, she realized she couldn't afford it. 

"They were wanting $231 a month. That was not doable," Bingham said. She’s been paying out-of-pocket for doctor’s appointments ever since: $60 for primary care, $200 for the dentist. Luckily, her daughter’s a healthy kid, she said.


From naming local post offices for fallen service members to changing the president’s signature health-care law, area lawmakers are beginning the 114th Congress ready to introduce a wide array of legislative proposals.

Every session of Congress sees far more bills introduced than could ever be considered, and most legislative proposals last only about as long as it takes a lawmaker to issue a news release announcing the bill’s introduction.

President and CEO, Maryann Reese, stands in front of St. Elizabeth's Hospital in downtown Belleville, IL. The current building was completed in 1954.
Durrie Bouscaren | St. Louis Public Radio

Update 12/16/14: St. Elizabeth's Hospital has asked the Illinois Health Facilities and Services Review Board to delay their planned vote over the hospital's move because not all board members will not be present at their December 16 meeting. The board's next meeting is January 27, 2015.

Adrian Clark | Flickr

Less than a month into the Affordable Care Act’s open enrollment period, there are some questions, but nowhere near the problems that were seen a year ago at this time.

“Compared to last year, it is going much smoother. The first day, about 500,000 people logged on and 100,000 people actually signed up for coverage, compared to last year when it took us over a month to get the website working,” said Sidney Watson, a Saint Louis University Health Law Policy Center professor.

Ryan White, the Indiana teenager who, after contracting AIDS at age 13, advocated for a more considered approach to those facing AIDS-related illnesses.
(via Wikimedia Commons/Wildhartlivie)

For people who live with HIV/AIDS, the cost of anti-retroviral medications, doctor’s visits and other medical care can quickly amount to thousands of dollars each month. Health insurance can keep these costs affordable, and the federal Ryan White program pays the cost of insurance for Missourians who meet certain income guidelines. 

But choosing a plan that works for people living with HIV can still be a challenge, and it’s a process Tom Kribben knows well.

U.S. Rep. Lacy Clay speaks with Rhonda and John Kiely at the health insurance resource fair at the St. Ann Community Center on Saturday, November 15, 2014.
Camille Phillips/St. Louis Public Radio

U.S. Rep. William Lacy Clay says he hopes more Missourians sign up for health insurance this year, now that the second year of open enrollment under the Affordable Care Act has begun.

More than 150,000 Missourians signed up for insurance last year—about half of those eligible. 

To mark the first day of open enrollment, the congressman visited a resource fair Saturday at the St. Ann Community Center in north St. Louis County. On-site navigators helped people sign up for health insurance, as vendors sold barbecue and salsa music played.

Dara Taylor of Community Catalyst.
Durrie Bouscaren / St. Louis Public Radio

On Saturday, open enrollment season for 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.

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?

Andre Wilson, an inclusive health advocate and transgender man, will speak at Washington University in St. Louis on Nov. 13 and 14.
Durrie Bouscaren / St. Louis Public Radio

Andre Wilson lived as a woman for the first 43 years of his life. It was excruciating, he said.

“I lived a life of depression, suicidality. I couldn’t even explain to myself, let alone others, what the barriers were,” Wilson said. “One lives a life of never having access to the core self.”

When Wilson began hormone therapy to transition into becoming a man, everything changed.

Adrian Clark | Flickr

On Monday, Missourians had their first glimpse at the health insurance rates they can choose from on the federal exchange. According to some, that shouldn't have been the first time the information was public.

Missouri is one of only a few states that does not have a state entity tasked with reviewing health insurance rates before they are finalized. Consumer groups say that means Missourians might be paying more for health insurance on the federal exchange than they should be. 

Adrian Clark | Flickr

Even though open enrollment doesn't start for several days, began on Monday to allow visitors to take a peek at the individual health insurance plans and rates that will be available for 2015. 

In the St. Louis area, two additional insurance companies  — Cigna and UnitedHealthcare — began offering plans on the federal exchange. For zip codes in St. Louis, the marketplace lists 41 plans with varying monthly premiums, co-pays and deductibles.

Ryan Barker of Cover Missouri said the additional competition likely led to a slight decrease in plan prices.

Dara Taylor of Community Catalyst.
Durrie Bouscaren / St. Louis Public Radio

At a YMCA in North St. Louis, Nancy Kelley of the Missouri Foundation for Health coached about 50 navigators on how to encourage people to purchase health insurance this year.

“In some ways, we got the easy people last year. Maybe they were motivated, maybe they had some knowledge about the marketplace. So we need to get creative,” Kelley told the crowd.

152,335 people bought health insurance on the federal exchange last year, according to the Cover Missouri Coalition. The organization’s goal is to bring the amount of uninsured Missourians below 5 percent in five years.

Rep. Paul Wieland, R-Imperial

The lawyer for state Rep. Paul Wieland, R-Imperial, predicts that his suit against mandated contraceptive coverage will help launch an avalanche of court challenges to the Affordable Care Act’s provision requiring insurance companies to offer such benefits.

But first Wieland needs to persuade a federal appeals court to reinstate his case. A lower court had tossed it out.