March 31, 2014 was the end of the first open enrollment period for Missouri’s Health Insurance Marketplace (with some exceptions). Since it opened October 1, 2013, nearly eight million Americans and approximately 153,000 Missourians have purchased health coverage. For many, the Marketplace offers financial assistance based on income, making health insurance a possibility for the first time for many people.
Yet, as a community, we must resist the urge to overlook the reality behind the numbers: African Americans in Missouri did not take advantage of the opportunities afforded by this new Marketplace.
Of the 152,335 individuals and families enrolling in our state, only 14,095 (or 9.3 percent) of the people enrolling who identified a race/ethnicity were African-American. (A quarter of the individuals purchasing insurance through the Marketplace did not identify any race/ethnicity in the post-application survey.) According to the Department of Health and Human Services, 612,000 African Americans in Missouri were eligible for insurance through the Marketplace, with 130,000 of these individuals being currently uninsured.
To be more specific, in the St. Louis area there are in excess of 74,000 individuals who would be insured today if they had gone to www.healthcare.gov or www.CoverMissouri.org when enrollment was open to start learning more about the process of getting enrolled. In 2015, this trend must change.
Purchasing health insurance through the Marketplace does not address all of the challenges of covering the uninsured. In the past two years, Missouri has failed to pass legislation that would expand Medicaid to the state’s citizens who are both in the greatest need of assistance and yet are least likely to be able to afford health insurance.
But who are we really talking about? According to a study by the federal Office of Minority Health, nearly 2 out of every 5 African-American males younger than 35 years old are uninsured nationally. A majority (59 percent) of these same men reported having income that made them ineligible for Medicaid.
One of the aims of the Affordable Care Act is to increase access to, and the affordability of, health insurance. Expanding Medicaid eligibility moves us closer to achieving this goal; therefore, the law needs to be implemented in a way that reaches the uninsured in a comprehensive and respectful manner.
Health insurance conjures for many images of bothersome paperwork, dreaded expense and awkward visits to intimidating health centers. But it is a matter of wellness versus illness, of extended life versus premature death. Thousands of African Americans do not have health insurance, and as a result they live sicker and die younger. On November 15, when the Marketplace once again opens for enrollment, we hope many of the 74,000 who didn’t enroll this year will do so.
Last year, the Missouri Foundation for Health contributed to the efforts to make enrollment easier by funding in-person enrollment assistance across the state, and it will do so again this year. We are aligned with the foundation in its commitment to reducing the ethnic, racial and economic barriers that adversely affect African Americans. We believe in a comprehensive approach to addressing race-based health disparities in this region, but this effort must include the basic personal responsibility for individuals to insure their own health now that health insurance is more accessible.
The Missouri Foundation for Health (mffh.org) contributed to this editorial.
