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Highest percentage of Missouri's uninsured reside in rural counties

This article first appeared in the St. Louis Beacon, July 11, 2012 - Most Missouri counties with the highest percentage of uninsured residents are concentrated in two congressional districts -- the 6th in the northern part of the state and the 8th in southeast Missouri, according to data in a new report.

The study does not break down the number of uninsured Missourians by congressional districts. But that is one way to look at the issue as federal lawmakers decide whether to try to reverse all or parts of the health reform law that will give most people access to health insurance by 2014.

The report comes from Cover Missouri, a joint project of the Missouri Foundation for Health and the Health Care Foundation of Greater Kansas City. It offers these estimates of how the Affordable Care Act could drastically change access to health insurance across the state:

• As a result of ACA, 509,529 Missouri residents under age 65, or 10 percent of the population, are expected to become newly insured. That's roughly two-thirds of Missouri's uninsured population of more than 800,000. 

• The highest percentage of the state's newly insured are likely to live in Knox, Hickory, Ozark, Morgan, Carter, Taney, Worth, Scott and McDonald counties. These also happen to be rural counties where the uninsured rates range from 21 percent to 22.6 percent, the highest in the state.

• The largest number of newly insured residents -- roughly 70,000 -- is likely to live in Jackson County, which includes Kansas City.  The second largest number, about 60,000, is likely to live in St. Louis County, while the third highest number, 40,000, is expected to live in St. Louis.

While the largest number of residents getting help from ACA lives in urban communities, the largest percentage benefitting from the law live in rural Missouri, says Ryan Barker, director of health policy at MFH.

In spite of reducing the state's uninsured population, the reform legislation would still mean 255,246, or 5.1 percent of Missourians, are likely to remain without health insurance, he said.

"Some will be legal immigrants who are ineligible for Medicaid for the first five years, and some will be undocumented immigrants," Ryan says of those left out of the law. "Some will be people who get exemptions."

These include people claiming religious exemptions from the law or claiming financial hardship, Barker said.

He says some of those left out would have some access to health care because funds will go toward uncompensated care provided by hospitals. And, he adds, "the law forbidding hospitals to turn away sick people still stands."

The study assumes that Missouri will move forward on two contentious issues -- expanding Medicaid and setting up an insurance exchange to cover the report's projected 509,529 Missouri residents eligible for insurance under ACA.

Many state lawmakers have been lukewarm to hostile to both issues.

Barker says MFH hopes the data will help policymakers understand which people do and don't have access to health insurance.  He says that's one reason the study didn't just look at the issue at the state level but focused on how the numbers would differ from county to county under health reform law.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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