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Health insurance in Missouri
Missouri’s health marketplace
Missouri utilizes the federally facilitated marketplace, which means residents enroll through HealthCare.gov if they want a plan through the exchange.
Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
Three insurers – Oscar Health, SSM Health Insurance, and Cox Health Systems joined the exchange for 2020 – bringing the number of insurers to seven.
Read our guide to the Missouri health insurance marketplace.
Missouri enrollment in qualified health plans
As in most states, Missouri’s exchange enrollment peaked in 2016, when 290,201 Missouri residents enrolled in private plans through the exchange. Enrollment declined in 2017, 2018, and again in 2019, when just 220,461 people enrolled.
Enrollment dropped again in 2020, with 202,750 people enrolled in plans through the exchange during the open enrollment period 2020.
Read more about Missouri’s health marketplace.
Missouri still has not expanded Medicaid
Missouri has not expanded Medicaid under the Affordable Care Act (ACA). Non-disabled adults without children are not eligible for Medicaid regardless of how low their income is, and parents with dependent children are only eligible with incomes that don’t exceed 22 percent of the poverty level. Only Texas and Alabama have lower Medicaid eligibility caps, at 18 percent.
Because subsidies are only available in the exchange for people whose household incomes are at least 100 percent of poverty, there are an estimated 113,000 people in Missouri who are in the coverage gap and have no realistic access to health insurance. They aren’t eligible for Medicaid or for subsidies to offset the cost of private insurance.
But Missouri residents may get a chance to vote on Medicaid expansion in the 2020 election, as signatures are being collected to get the measure on the ballot.
Read more about Medicaid in Missouri.
Short-term health insurance in Missouri
Missouri does not follow the new federal regulations on short-term health plans. Instead, state regulations limit short-term health plans to terms of no more than six months. The state does not limit renewals of short-term plans.
Missouri lawmakers had considered a bill to extend short-term plans, but it did not pass.
Read more about short-term health insurance in Missouri.
Missouri and the Affordable Care Act
Missouri resisted the implementation of the Affordable Care Act, opting for a federally facilitated exchange and declining Medicaid expansion. The state favored Trump in the 2016 presidential election, with 57.1 percent of its voters choosing the Republican candidate, who campaigned on a promise to repeal Obamacare.
Yet, despite Trump’s popularity in Missouri, the Show-Me State has seen healthcare access improvements on par with the national average since the Affordable Care Act took effect. Missouri’s uninsured rate, according to U.S. Census data, was 13 percent in 2013. It fell gradually over the next three years, reaching 8.9 percent by 2016. But it had increased to 9.4 percent in 2018 (there has been a nationwide uptick in the uninsured rate under the Trump administration took office).
In 2019, more than 166,000 Missouri residents were receiving premium subsidies to offset the cost of their individual market health insurance. The subsidies averaged $578/month, which covered the vast majority of the average pre-subsidy premium ($646/month).
In addition, people with pre-existing conditions no longer face exclusion riders, higher-than-standard rates, or declines in the individual market, nor do they face pre-existing condition waiting periods on employer-sponsored health insurance plans. This is all a result of the ACA and its landmark health care reforms.
Missouri and the Affordable Care Act
Missouri has balked at the Affordable Care Act. It refused to implement a state-run marketplace, rejected Medicaid expansion, and passed a law to restrict consumer assistance; however, a court ruling blocked enforcement of the law.
In the 2010 U.S. Senate vote on the ACA, Sen. Claire McCaskill, a Democrat, voted “yes,” while Sen. Christopher Bond, a Republican, voted “no.” Republican Sen. Roy Blunt has replaced Bond in the Senate.
Blunt voted against the ACA as a U.S. representative from Missouri in 2010, and has consistently voted against the ACA and similar reform measures, and in favor of bills that would unravel the ACA.
McCaskill defended the ACA, but she lost her re-election bid in 2018 to Josh Hawley, so both of Missouri’s senators are now Republicans. Hawley campaigned on a promise to protect people with pre-existing medical conditions, but as Missouri’s Attorney General, he joined in a lawsuit that would gut the ACA, including its pre-existing condition protections. Hawley claimed that his plan in supporting the lawsuit is to overturn the ACA and replace it with a new health care bill once he’s in the Senate. It’s notable, however, that none of the GOP bills that were considered in 2017 to repeal the ACA would have adequately protected people with pre-existing conditions.
Missouri’s U.S. representatives voted 6-3 against the ACA in 2010. Missouri has since lost a House seat, and as of 2020, Republicans have a 6-2 majority.
Republicans hold strong majorities in both the Missouri House and Senate. In 2016, Former US Navy SEAL Eric Greitens (a former Democrat, now a Republican), won the gubernatorial election in Missouri, and took office in January 2017. Greitens opposed Medicaid expansion because of the cost to the state (states pay 10 percent of the cost, while the federal government pays 90 percent).
Greitens was only in office until mid-2018, when he resigned amid multiple scandals. Lieutenant Governor Mike Parson assumed the governor’s office at that point, and the next election will take place in 2020. One of Parson’s first acts as governor was to eliminate Medicaid funding for preventive care obtained at Planned Parenthood.
Does Missouri have a high-risk pool?
The Missouri Health Insurance Pool (MHIP) was created in 1991 to provide health insurance for people who were denied coverage in the private individual insurance market because of their medical history. But medical history is no longer an eligibility factor for private health insurance, making high-risk pools largely unnecessary now that the ACA has been implemented.
In 2013, the Missouri legislature passed SB262, which allowed MHIP to cease operations on January 1, 2014, and transition members to coverage in the private market instead.
Medicare enrollment in the state of Missouri
Missouri Medicare enrollment reached 1,234,904 by late 2019. You can read more about Medicare in Missouri in our state guide, including details about Medicare Advantage, Medigap, and Medicare Part D.
State health insurance legislation
Here’s a summary of other recent Missouri legislation related to health reform: