Missouri Consumers In The Dark As Health Insurance Exchange Nears
By Virginia Young, St. Louis Post-Dispatch
Aug 20, 2013 - Kaiser Health News
This story was produced in partnership with the ST.LOUIS POST-DISPATCH
JEFFERSON CITY -- You wonft find Dwight Finefs name on the Missouri state
payroll. But the retired hospital association executive has been working for
state government the last three years.
In health care circles, hefs known as the statefs Affordable Care Act
coordinator. The Missouri Foundation for Health, a St. Louis-based nonprofit
group, pays Finefs salary and gloansh him to the state. He reports to the social
services director.
Having an invisible coordinator is just one example of how the administration
of Gov. Jay Nixon, a Democrat, has walked a political tightrope as the state
gets ready for a federal initiative that the Republican-led Legislature strongly
opposes and state voters have weighed in against — twice.
The keystone of the law — an online marketplace where uninsured consumers can
buy insurance, often with federal subsidies — is shrouded in secrecy in
Missouri.
Unlike some states, which have released detailed information about the
proposed premiums that insurers will charge for policies sold through the
exchange, Missouri wonft provide any hints.
Last November, Missouri voters overwhelmingly approved a law that barred
Nixon from setting up the exchange without legislative or voter approval. As a
result, the federal government will operate Missourifs exchange.
Sen. Rob Schaaf, R-St. Joseph, championed the ballot measure and is a vocal
critic of the federal Affordable Care Act, sometimes called Obamacare. Schaaf, a
physician, said government shouldnft expand the social safety net when the
current system is broken.
gIs it the place of government to provide everything for everyone? I donft
think it is. What we really need to do is reduce the cost of health care by
putting competition into the health care market,h Schaaf said.
Citing the voter-approved restrictions, the statefs top insurance regulator,
John Huff, declined through a spokesman to be interviewed about the exchange,
which makes its debut in seven weeks.
The state gis not participating with the federal government in the
administration of the health insurance exchange that will be used by Missouri
residents,h said Hufffs spokesman, Chris Cline.
In a chance encounter in a state office building stairwell on Monday, Huff
added: gWefre in the lanes wefre allowed to be in.h
The statefs silence means Missourians wonft know anything about the
affordability of plans offered through the new marketplace until federal
officials release the details.
The Centers for Medicare and Medicaid Services has said that final
certification decisions on the plans will be made by Sept. 4 and information
will be posted on the
healthcare.gov website after that. The exchange opens Oct. 1.
The information vacuum troubles advocates for the uninsured, as well as some
staunch opponents of the law.
gI do think, unfortunately, that wefre going to have an unusually difficult
time here,h said Jeanette Mott Oxford, executive director of the Missouri
Association for Social Welfare, which lobbies for policies that help low-income
residents. gThere is a lot of confusion, and people are not getting enough
information about it.h
Missouri is one of 19 states that ceded full control of its exchange to the
federal government. Fifteen states are partnering with the federal government.
Sixteen states and the District of Columbia are building their own
exchanges.
U.S. Sen. Roy Blunt, R-Mo., a critic of Obamacare, called this week for
federal officials to release the premium information by Aug. 26 in Missouri and
the 33 other states where the federal government is involved in negotiating
rates.
Blunt said families needed time to plan for insurance costs, which he
contends will rise under the law.
However, in some states, such as New York, officials have said premiums for
individual policies will drop. The analysis is complicated by the fact that
policies offered through the exchanges will cover a wider range of benefits than
most individual plans cover now.
Spreading The Word
Though they donft know how much the new plans will cost, Missourifs social
services agencies and community groups that work with the uninsured are gearing
up to spread the word about the exchange.
The Foundation for Healthfs board is expected to vote next week to supply
$1.1 million worth of posters, wallet cards and other promotional materials
about the exchange. An additional $5 million in grants will be distributed to
groups to hire gcertified application counselorsh to help with online
sign-ups.
The information blitz is needed, said Tonya Cain, 40, a single mother from
Cedar Hill, Mo. She is unemployed and needs insurance.
Cain relied on the emergency room at the SSM St. Clare Health Center near
Fenton when she had severe abdominal pain. Afterward, she said, she gwent
scrappingh — picking up aluminum cans to sell — to pay for the pain pills and
other drugs prescribed for a ruptured cyst on her ovaries.
She said she had no information about the exchange.
gI just know that everybodyfs talking about Obamacare, that itfs supposed to
start the first of January. Thatfs it. No more information, no brochures,h Cain
said.
To add to the confusion, the goal posts keep moving.
The New York
Times reported last week that President Barack Obamafs administration has
delayed until 2015 a limit on how much people must spend in some group health
plans on out-of-pocket costs, such as deductibles and co-payments.
The delay follows last monthfs one-year delay in a requirement that larger
employers offer health coverage to full-time employees.
An estimated 877,000 Missourians are uninsured. The federal law intended for
them to gain health coverage either through Medicaid, the public insurance
program for the poor, or the exchanges.
But the U.S. Supreme Court made the Medicaid expansion optional for states,
and Missouri legislators rejected it. That will leave an estimated 226,525
Missourians below the poverty line without any type of subsidized coverage.
About 350,000 people may be eligible for the federal subsidies.
Fine, the state ACA coordinator, said his role centered on the statefs
transition to a Web-based enrollment system for Medicaid. Information typed into
the federal exchange portal is supposed to automatically transfer to the state
website if the person is Medicaid-eligible.
Obamacare opponents delayed the software changes for several years, leaving
the contractor only four months to do the job before the Oct. 1 launch. Still,
Fine said he was greasonably optimistich that the work would be done on
time.
gItfs a tight timeline, but we have a clear sense of what needs to be done,h
he said.
© 2013 Henry J. Kaiser Family Foundation. All rights reserved.