NYTimes.com: Missouri Citizens Face Obstacles to Coverage
By ROBERT PEAR
The insurance marketplace established under President Obama?s health law has no visible presence in Missouri, which stands out among states resisting the effort.
Missouri Citizens Face Obstacles to Coverage
Steve Hebert for The New York Times
Kat Cunningham, right, president of a Missouri business service firm, has been deluged with health insurance questions.
By ROBERT PEAR
Published: August 2, 2013 440 Comments
JEFFERSON CITY, Mo. — Looking for the new health insurance marketplace, set to open in this state in two months, is like searching for a unicorn.
In Colorado, an Opposite Approach
By ABBY GOODNOUGH
In contrast to Missouri, Colorado is embracing Obamacare. The health insurance marketplace is advertising on TV, radio and public transit and emissaries are traveling the state to explain how it will work.
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Steve Hebert for The New York Times
David R. Griggs, who owns a carpet store in Columbia, Mo., said he has not “heard a word about” insurance exchanges.
The marketplace, or exchange, being established by the federal government under President Obama’s health care law has no visible presence here, no local office, no official voice in the state and no board of local advisers. It is being run like a covert operation, with no marketing or detailed information about its products or their prices.
While states like Colorado, Connecticut and California race to offer subsidized insurance to their citizens, Missouri stands out among the states that have put up significant obstacles. It has refused to create an insurance exchange, leaving the job to the federal government. It has forbidden state and local government officials to cooperate with the federal exchange.
It has required insurance counselors to get state licenses before they can help consumers navigate the new insurance market. And, like many states, it has refused to expand Medicaid.
“It’s like running an obstacle course every day of the week, but the course changes from day to day,” said Herb B. Kuhn, president of the Missouri Hospital Association, a strong advocate of expanded coverage.
State Senator Rob Schaaf, the Republican author of a 2012 ballot measure that prevented the state from setting up its own insurance exchange, said: “We can’t afford everything we do now, let alone provide free medical care to able-bodied adults. I have a philosophical problem with doing that, and I’m also worried about our country’s financial situation.”
Over 850,000 Missouri residents, including low-income people in St. Louis and Kansas City, family farmers and small-business employees, are uninsured. Many could qualify for coverage through the exchange, which encourages competition and offers subsidies to reduce costs.
Kenneth L. Schmidt, an insurance broker in St. Louis who intends to sell insurance products offered on the exchange, said: “We have not seen any evidence of the federal exchange — how it will be run, how it will be structured in Missouri. Will it be run from Jefferson City? Will it be run from Washington? Who will watch over it? No clue.”
David R. Griggs, who owns a carpet store with 15 employees in Columbia, Mo., said he was hungry for information about the exchange. But, he said, “I have not seen or heard a word about it.”
Kat Cunningham of Columbia, the president of Moresource, a firm that handles payroll and benefits for more than 600 employers, said she had been deluged with questions from clients and was struggling to provide guidance.
She said her clients wanted to know: “Where do we go to purchase health care coverage? How much will it cost us? If we can’t afford it, what then?”
Private foundations and community groups have stepped into the vacuum. M. Ryan Barker, vice president of the Missouri Foundation for Health, said his organization planned to spend $8 million this year on a campaign to secure coverage for 200,000 of the uninsured. “The state government is not doing a whole lot, its hands are tied, so we are taking on a bigger role,” he said.
Jennifer G. Bersdale, executive director of Missouri Health Care for All, a grass-roots organization, has been educating thousands of people about what she sees as an exhilarating prospect. “People who have been shut out of the market for years will soon be able to get good insurance, cannot be denied because of pre-existing conditions and can get financial assistance to afford it,” she said.
Missouri is one of a handful of states where the federal government directly enforces the consumer protections of the Affordable Care Act because the state lacks the authority to do so. In 2010, Missouri voters overwhelmingly approved a ballot measure expressing opposition to the federal requirement for most Americans to have health insurance.
In November 2012, voters approved a ballot measure that prohibits the governor and other state officials from establishing or operating a state-based insurance exchange unless authorized by a vote of the people or by the state legislature. The measure says state and local officials cannot provide “assistance or resources of any kind” to a federal exchange unless such assistance is specifically required by federal law. It authorizes taxpayers and state legislators to sue state and local officials who flout its restrictions. The threat of lawsuits has made local officials cautious.
Gov. Jay Nixon, a Democrat, said debate on the ballot measures had been highly political. He has held dozens of events to promote the expansion of Medicaid, stressing its economic benefits for the state. But Republicans hold two-thirds of the seats in each house of the legislature.
“A core principle of public health is to increase access to health care,” said Josephine P. Waltman, the health officer for Phelps County. But, she said, the ballot measure limits what local officials can do and is forcing them to consult lawyers.
As a result, Ms. Waltman said she and her staff would distribute general information about the insurance exchange, but would not sit down with people at computers to help them choose health plans and see if they qualify for subsidies. “I would love to do that,” she said.
A version of this article appeared in print on August 3, 2013, on page A1 of the New York edition with the headline: Two States Reflect Divide On Obama’s Health Plan: A Coverage Effort Faces Hurdles in Missouri.
Share your thoughts.
- bob h
This is shaping up as a rare situation in which the states that pay most of the taxes, the Bluish states, will end up reaping most of the benefits from the healthcare law. This law would have represented another subsidy of the Red states, which have the poorest health and highest numbers of ininsured, by the taxpaying Blue states, but thanks to the barbarism of Republican leaders, that won't happen.
One wonders how all this affects the image of the United States abroad. Our longtime allies may see a rising strain of barbarism in our politics that may lead them to chart their own courses separate from us.
- Aug. 3, 2013 at 10:23 a.m.
How much federal money does Missouri get for streets and highways, schools and colleges, police and jails, industrial parks, agricultural subsidies, water and sewer projects, airports, tourism promotion, etc. etc.? I'd say it's time a few keyboard punching bureaucrats in Washington who process those grant and aid applications "profiled" those applications with MO in the address box and threw up a few "obstacles" of their own. Or heck, just say, "Sorry, Missouri, the federal money's all gone. You'll have to build it yourself. Maybe you can raise state taxes, huh?"
- Aug. 3, 2013 at 10:42 a.m.
- West Palm Beach, Florida
Yet the 60 % who oppose Obamacare are the same people who screamed that premiums are too high; that they can't get coverage due to a pre-existing conditions; that their private insurer dropped them due to too many claims. John Doe Public is ignorant and basically gets suckered by negative ads run by wealthy, conservative anti-government organizations and individuals like the Koch Brothers
- Aug. 3, 2013 at 10:49 a.m.
- ft. lauderdale
they oppose the name "obamacare". but when you ask if they are in favor of the individual benefits, such as, no pre existing exclusions, no lifetime caps, coverage of children in families up to age 26, etc., they are overwhelmingly for it. also many people are against obamacare because it doesn't go far enough; they want public option or just single payer for all (medicare for all).
republicans are misinformed because they don't want to be informed. they don't care about the welfare of the nation or people, they only care about power!
- Burr Ridge, IL
Obamacare has its problems --- but it was an effort to batch together various coalitions to control health care --- which other industrialized nations have realized need some form of government intervention. The Republican answer to this problem the usual, go after lawyers, deregulate, and for those that this does not work, go to the emergency room -- that's it. Again, ideology trumps pragmatic attempts at finding a solution. Ideologies are adopted to prove a point, not solve a problem.
- Aug. 3, 2013 at 10:53 a.m.
- William Kearns
- Walnut Creek, CA
State Senator Schaaf and his comment: “We can’t afford everything we do now, let alone provide free medical care to able-bodied adults. I have a philosophical problem with doing that, and I’m also worried about our country’s financial situation.” makes me remember when I was running 20-25 miles a week, and cycling 40-60 miles. I looked quite able-bodied, and was told after a few biopsies and a tumor removal, that I had non-hodgkins lymphoma and needed chemotherapy or I would die a horrible death. Health insurance through my employer helped to save my life, but that was in Texas some 16 years ago. What if I was in the same health challenge in Missouri without health insurance? Would he expect me to vote for Republican idiocracy and then die?
- Aug. 3, 2013 at 11:15 a.m.
- St. Louis, MO
I live in St. Louis, and I *desperately* need the exchange. I lost my job in 2012, and I recently lost my COBRA insurance coverage. I have a new job that I love, but it's part time and offers no health benefits. Because I am at high risk of developing breast cancer, I was turned down when I tried to apply for health insurance. Missouri does have a pre-Obamacare program to provide health insurance to people in my situation, but for a woman my age to get coverage, I would have to pay a minimum of $463/month, not including the deductible. That's over a third of my take-home pay! I'd really like to know what the Republican legislators in my state think I should to do if I get cancer.
- Aug. 3, 2013 at 11:23 a.m.
- Mary Becker
For those who need more information on the health insurance exchanges and marketplace, go to enrollmissouri.org. The site is continually updated with the latest information.
- Aug. 3, 2013 at 11:54 a.m.
- Coos Bay, OR
People don't seem to understand that having unhealthy people stock shelves, prepare food, go to schools, movies, sports and other places people congregate, is a bad thing, even from a totally self-interested point of view. Can you say "infectious"?
- Aug. 3, 2013 at 11:54 a.m.
- San Anselmo, CA
It perplexes me when Republicans respond with shock and outrage when one points out that their attitude amounts to: "if you don't have insurance, you're lazy and you've done something wrong and I don't really care if you live or die." They protest, "that's not my intention! I just have a philosophical problem with helping able-bodied people get medical care."
I hope none of these people finds themselves on the wrong side of luck. Although it might do something for their perspective.
- Aug. 3, 2013 at 1:44 p.m.
- New Jersey
This article made me sadder than any news story I've read in years, not that there hasn't been lots of competition.
The Republican Party's attempt to sabotage Obamacare -- stand in the hospital door, so to speak -- is so cynical and inhuman that it makes Alabama Gov. George Wallace's pledge to stand in the schoolhouse door to prevent racial integration in his state seem principled.
That this could be happening openly in so many states around our country makes real to me the degree to which our nation's political system has been heedlessly, perhaps even intentionally, broken by one of our two major parties.
So sad for the American people and the experiment we started more than 200 years ago. This just goes past anything I can remember in my 66 years as an American citizen.
- Aug. 3, 2013 at 1:47 p.m.
- Oak Park, IL
This story boggles the mind. Sen. Schaaf says "We can't afford...(to) provide free medical care to able-bodied adults." Does he understand that the ACA is designed to get these people insurance? What would his alternative be? Who are the people, and how many are there, who don't want insurance? And why would so many vote against requiring insurance? Those who have insurance should know that their premiums pad the pockets of insurance and hospital corporation executives, and cover the costs of uninsured and non-paying patients. We will never have a satisfactory system until everyone pays into and participates in some type of insurance fund, and health care providers charge reasonable and realistic rates for services, and these services are properly paid for.
- Aug. 3, 2013 at 1:56 p.m.
"We can’t afford everything we do now, let alone provide free medical care to able-bodied adults."
As I understand it, the federal government will be providing the subsidies, and under Medicaid expansion, the federal government will be picking up something like 90% of the tab. So the cost to Missouri would be very small compared to the benefits. Not to mention that the statesman's comment ignores the reality that many, many working people do not get benefits through their employer and cannot afford the outrageous cost of health insurance on their own.
As for those "able-bodied adults," the truth is that we already provide free medical care to them. If you'll notice, you don't see people dying in ditches. There is some byzantine network of organizations that reimburses hospitals for some of the costs. The hospitals overcharge paying customers to compensate. Bankruptcy courts around the country discharge millions in unpaid hospital bills. Etc. We made the decision a long time ago that we couldn't sit idly by and watch people die from easily prevented causes. The ACA was an attempt to rationalize the system and hopefully drive down the cost. Of course there is a possibility that it won't drive down the cost. But seeing that it's the only game in town, Missouri should give it a shot.
- Aug. 3, 2013 at 1:57 p.m.
- Robert Y
- St. Louis, MO
I live in St. Louis and while I am certainly disappointed with the state government's decisions on the ACA (specifically rejecting the Medicaid expansion and opting not to meaningfully help with the exchanges), I am also disappointed by the overwelming derisive response by the NYT readership who has commented on this piece.
Of course, Missouri should participate in the ACA. I do not disagree with the point. Rather than trying to understand why there is a populace that refuses to go along with it and try to work through those issues, all I see are insults, scorn, and cheap shots. It's no wonder we have such a fractured government; it's simply a reflection of our fractured society.
- Aug. 3, 2013 at 2:13 p.m.
- Trent Condellone
- Springfield, MO
I had John Ashcroft's old position as Evangel CR president, among other positions, back in the early 90's. I am appalled at the direction the Missouri GOP has traveled.
We have elderly in their 80's loosing coverage over $8 in income; we have a scandal ridden state house; and the state has went backward in every way possible.
Our people are our most basic foundation and responsibility. This state has failed them. I myself am a victim of bad health, always have been, and now the state has made me a victim of the healthcare system. I say to anybody ignorant enough to ask me about how I feel about my small business pay this or that healthcare tax - What small business? Healthcare expenses ruined everything we built. I'd gleefully pay any tax if I was restored to health. And I truly wish I had lived in another state - undoubtedly, had I received care when I needed it, I'd still be happy and in business.
They sit in fine homes, next to gov't built lakes, gov't bailed out 'private' airports, gov't built highways, businesses built generous tax credits, and pontificate about how people are better off without gov't. They discarded the policies of the 1990's GOP in re healthcare, but claim to be pro life - in reality is there is zero compassion for any born person. They spread outright lies about availability of care, and will soon bankrupt our rural hospitals. Created middlemen and eliminated gov't help to those trying to get insurance via the new laws. It's just plain evil.
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