In 2010, nearly 16 percent of Missourians reported they were unable to see a doctor when necessary due to cost. The cost of health insurance for Missouri families increased 38 percent between 2003 and 2009, with average annual premiums reaching $12,353. This amount represents nearly 26 percent of the median household income in Missouri. Single policyholders saw their premiums increase by 33 percent over this same period.  Of the Missouri residents who do have health insurance, 50 percent are covered through their employment. Public programs such as Medicare and Medicaid insure 29 percent of the population, and six percent of residents purchase individual private plans. This leaves 14 percent of Missourians uninsured. 
Who are the uninsured in Missouri?
Missouri’s children are uninsured at a rate of 10 percent. Among non-elderly adults, those younger than 65, the uninsured rate climbs to 19 percent. The rate of uninsured children doubles to 20 percent for children living in households with annual incomes less than 139 percent of the federal poverty level. Non-elderly adults in these lower-income homes are uninsured at a rate of 40 percent.  The uninsured rate among the non-elderly Hispanic population is 30 percent in Missouri. Blacks are uninsured at a rate of 25 percent, and of the non-elderly White population, 15 percent lack health insurance.
How does the Affordable Care Act affect Missouri residents?
The Affordable Care Act (ACA) requires states provide access to an online marketplace, also called an exchange, where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government.
Missouri Governor Jay Nixon initially sought to establish a state-based health insurance exchange, but did not receive support from legislators. In the November 6, 2012 general election, Missouri voters passed a measure (Proposition E) that blocked the governor from establishing an exchange through executive order. Therefore, the health insurance exchange of Missouri, by default, will be run by the federal government. Residents of Missouri can access the federal exchange to compare and purchase quality health insurance through HealthCare.gov.
Under ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services and mental health treatments. Annual wellness checkups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.
Missouri’s health insurance exchange
Beginning October 1, Missouri residents can enroll in health plans at the federal website Healthcare.gov for health insurance effective January 1, 2014. Plans offered to Missourians cover essential health benefits based on Anthem Blue Cross Blue Shield’s Blue Access Choice PPO Medical Option plan. The federal website has a web chat function, and may be accessed with mobile devices. The site also offers information about available tax credits and subsidies. For assistance by phone, consumers may reach the call center 24-hours a day at 1-800-318-2596.
Small Business Health Options Program (SHOP)
Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.
Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.
For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Missouri small business owners may access SHOP through HealthCare.gov. For more information about the ACA and small businesses, visit the U.S. Small Business Administration.
Certified in-person enrollment organizations
The U.S. Department of Health and Human Services has approved the health centers below in Missouri for assistance in outreach and enrollment.
- Advocates For A Healthy Community Inc.
- Betty Jean Kerr – People’s Health Centers
- Community Health Center Of Central Missouri
- Community Treatment, Inc
- Crider Health Center, Inc.
- Cross Trails Medical Center
- Douglas County Public Health Services Group, Inc.
- Family Care Health Centers
- Family Health Center
- Grace Hill Health Centers, Inc.
- Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
- Northeast Missouri Health Council, Inc.
- Northwest Health Services, Inc.
- Ozark Tri-County Health Care Consortium
- Regional Health Care Clinic, Inc.
- Rural Alliance For Better Family Health
- Samuel U. Rodgers Community Health Center, Inc.
- Southeast Missouri Health Network
- Swope Health Services
For the most current list, visit the U.S. Department of Health and Human Services.
External resources for Missouri residents
- Centers for Medicare & Medicaid Services
- Cover USA.org
- The Kaiser Family Foundation
- Missouri Department of Insurance
- State Refor(u)m
Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.