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Missouri and Health Reform

The state of Missouri was against the Affordable Care Act during its implementation. Not only officials, but residents weren’t fond of the law, which was proven by a majority vote passing a ballot blocking their Governor from creating an exchange. Since 2010, the state made various efforts to stop health reform on the state level. Although statewide measures were successful to a point, the federal law still took root throughout Missouri. Despite their anti-health reform ballot initiative started in 2010, the surface has nonetheless been scratched.

From the signing of Obamacare, Missourians have had access to the temporary high-risk pool for pre-existing conditions, the health insurance exchange, guaranteed issue coverage, and extended coverage as a dependent child to age 26, in addition to other innovations. Insurers in the state have also been required to make significant changes, leading to a smoother application process for most residents, and more reasonably priced options on the individual market.

A selection of key reforms affecting the individual market in Missouri are included below.


Health Reform Laws in Missouri: 2010-2013

In the first three years of the law, numerous adjustments to health insurance had already been made. These include a few changes to health insurance in Missouri. Insurers are no longer permitted to cancel a policy without a good reason, such as fraud, nonpayment, or intentional misrepresentation. Companies also cannot rescind a health plan if an applicant made a mistake on their application. Additionally, there are no more lifetime maximums, and annual dollar limits were phased out until eliminated by 2014.

Pre-existing conditions were first addressed only for Missouri residents up to age 18, who could not be denied coverage by any insurer for their health. As this is much less frequently occurring than adults with pre-existing conditions applying for health insurance, the impact was mild. Also, these young residents were still subject to rate ups for their condition. For adults with a qualifying condition, the Missouri Health Insurance Pool added a federal pool in 2011 to accommodate the sick and uninsured with a selection of health plans.

During this period, Missouri insurers began to cover in-network preventive care at 100 percent through most of their health insurance products. Each health plan’s contracted network offers cancer screenings for women and men, well-child visits, immunizations, and other services for no extra charge. Additional types of preventive care for women were passed as mandatory in 2012, such as contraceptives, pap tests, yearly exams, HPV screenings, and breastfeeding assistance.


Missouri Health Reform: 2014 and Later

Beginning in January 2014, Obamacare changes to individual insurance became more tangible, including guaranteed issue coverage and nondiscrimination laws. In addition to positive changes, there is the requirement for health insurance known as the individual mandate, which imposes a tax on uninsured Missourians. While the penalty is initially small, it increases over time, making coverage seem a better option. If you are a low-income resident, however, you may not receive a penalty depending on your earnings.

The ACA also introduced tax credits, awarded those who may not be able to afford a health plan. Subsidies cover premiums and even cost sharing for those who earn between 100 and 250 percent of poverty and apply for coverage on the Missouri health insurance marketplace.

As Missouri secured by vote, its health insurance exchange is not state-run, and is managed by federal agencies. Various Missouri insurers offer subsidized coverage through the marketplace so that residents can afford to get insured.

The private market, and all Missouri insurers must accept individuals over 18 with pre-existing conditions without raising their premiums declining them entirely. Insurers in Missouri also lost the right to issue exclusions and elimination riders in 2014. While a health plan may not offer to cover services related to a person’s illness, they cannot specifically exclude any type of care.

Insurance companies also include ten categories of essential health benefits under the law in comprehensive plans inside and outside of the marketplace. Benefits include services that are already covered by some but not all plans, such as emergency room visits, maternity care, and prescriptions.

The Governor of Missouri, Jay Nixon (D), expressed an interest in going forward with Medicaid expansion in 2014. Republican lawmakers have spoken since the election on how they will gladly turn down funding for the program and are assured it will be far too expensive and problematic, and will likely continue to make expansion difficult. However, as of late November 2012, Gov. Nixon stated, “it’s the smart thing to do, because if we take a pass on billions of health care dollars… the money will go to other states… They’ll get the benefit. We’ll get the bill. That’s not smart.”¹

This means more low-income Missourians would receive health benefits if the state expanded. It still has not moved forward with Medicaid expansion under the Affordable Care Act, which allows individuals with income up to 133 percent of the federal poverty level to enroll. MO HealthNet would be offered to a wider group of needy residents if the state chose to expand.





1. (29 Nov. 2012) Kaiser Health News. “Missouri Governor Backs Medicaid Expansion.” http://capsules.kaiserhealthnews.org/index.php/2012/11/missouri-governor-backs-medicaid-expansion/