Overall, Missouri has been against the Affordable Care Act, as is evidenced from a majority of voters passing a ballot to prevent their Governor from creating an exchange. Throughout the past two years, the state has taken efforts to stop health reform as best they can on the state level. Though the measures taken to stop health reform in Missouri have been humored, the federal law is stronger than the state, and Missouri is required to adhere to the ACA as all other states. While this has brought intense frustration for some Missourians, it has been able to assist others, if they choose to view it as such. Despite their anti-health reform ballot initiative started in 2010, the surface has nonetheless been scratched.
Thus far, Missourians still have the ability to participate in the federal high-risk pool if they have a pre-existing condition and no insurance, as well as receiving extended coverage as a dependent child to age 26. Other laws to which the state of Missouri must adhere are explained further.
Current Health Reform Laws in Missouri
Since 2010, several adjustments to health care have already been made, though not the key aspects of the law. These include a few changes to health insurance in Missouri, such as placing a ban on a health insurer’s ability to cancel a policy without a good reason, such as fraud, nonpayment, or intentional misrepresentation. Insurers can no longer rescind a health plan if you made a mistake on your application form. Additionally, there are no more lifetime maximums, though annual dollar limits are being currently phased out until their elimination in 2014.
Pre-existing conditions have been addressed only for Missouri residents up to age 18, who cannot 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 has been mild. Also, these young residents are still subject to rate ups for their condition. For adults with a qualifying condition, the Missouri Health Insurance Pool added a federal pool in 2010 to accommodate the sick an uninsured with a selection of health plans.
Missouri also must include preventive care as a free service in every insurance plan in the state. Now each health plan’s contracted network offers cancer screenings for women and men of a certain age, well-child visits, immunizations, and other services for no extra charge. Additional types of preventive care for women were passed as mandatory in Missouri and around the country, such as contraceptives, pap tests, yearly exams, HPV screenings, and breastfeeding assistance.
Missouri Health Reform in 2014
On the first of January, 2014, the majority of the health care law will take its most drastic effects on individual health insurance, as Missouri residents are likely aware. This date will bring a time of required health insurance with a penalty for a lack of participation, the individual mandate. While the penalty is small, the options for health insurance will be many. If you are a low-income resident, however, you will not receive a penalty depending on your earnings. The ACA also approves the use of tax credits to those who may not be able to afford a health plan, paying a large portion of the premiums.
As Missouri has secured by vote, their health insurance exchange will not be set up by the state, and will be government-run as they have opted out of organizing this form of insurance. The exchanges offer an individual health plan from the government available online, and providing coverage that rivals the private market.
The private market, and all Missouri insurers will have to accept individuals over 18 with pre-existing conditions, of any gender, without raising their premiums over 10 percent or declining them entirely. Insurers in Missouri also lose the right to exclusions and elimination riders in 2014. Those who are accepted for coverage will have the insurance company cover some portion of care related to their condition, if needed.
Insurance companies will also need to meet federal criteria for mandatory benefits, which must include ten categories of care. The state will choose which benefit categories each insurer will carry, based on the success of their existing health plans. Benefits may include services that are already covered by some but not all plans, such as emergency, maternity, vision, and dental care, and prescriptions.
The Governor of Missouri, Jay Nixon (D), has 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 can look to receiving health benefits next year. Medicaid expansion under the Affordable Care act includes individuals with income up to 133 percent of the federal poverty level, which is currently $14,856 per year for one person, and $29,965 for a family of four. MO HealthNet will be offered will all of the comprehensive benefits, but now to a wider audience.
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/