For all the disdain that Missouri legislative Republicans have for the Affordable Care Act, known as Obamacare, Missourians have enrolled in large numbers in search of family health care.
According to the ACA website HealthCare.gov, 250,341 people enrolled in plans through Missouri’s marketplace during the open enrollment period for 2022 coverage. This is 35,000 enrollments higher than the 2021 enrollment period, and the highest enrollment in Missouri’s exchange since 2016.
The ACA enrollment period opened on Nov. 1, 2022, and the deadlines for coverage in 2023 are Dec. 15 for coverage that starts Jan. 1, and Jan. 15 for coverage that begins Feb. 1.
Black and Latino Americans are a major part of the surge in enrollment here, and throughout the nation, according to a recently released Department of Health and Human Service study.
Enrollment in ACA health care marketplace plans increased around 50% for Black and Latino Americans between 2020 and 2022, according to HHS analysis.
“This report shows that our efforts are working, including among Black, Latino, and American Indian and Alaska Native consumers,” HHS Secretary Xavier Becerra said in a release.
“The uninsured rate is at a record low in the country, but we know we have more to do to close gaps in coverage and increase equity.”
According to an HHS August report, open enrollment period from Nov. 1 to Dec. 15, 2021 “saw an all-time high in Marketplace sign-ups of 14.5 million.”
“In addition, recent adoption of the ACA Medicaid expansion in several states [including Missouri] has extended Medicaid coverage to low-income adults up to 138% of the Federal Poverty Level (FPL).”
This number was increased by administrative and legislative actions including an extended 2021 special enrollment period and implementation of expanded Marketplace subsidies under the American Rescue Plan.
It matters in Missouri
The Show Me State bucked a national trend following passage of Medicaid expansion and repeated GOP attempts to derail enrollment and state financial support.
According to health.gov, marketplace enrollment tends to drop after a state expands Medicaid because people with incomes between 100% and 138% of the poverty level shift from subsidized marketplace coverage to Medicaid. Medicaid expansion began in the fall of 2021, yet enrollment in Missouri’s marketplace plans still grew for 2022.
Again, despite Republican contempt in Jefferson City, Missouri has seen healthcare access improvements on par with the national average since the Affordable Care Act took effect.
According to U.S. Census date, Missouri’s uninsured rate, stood at 13% in 2013. It fell gradually over the next three years, reaching 8.9% by 2016. It jumped to 9.4% in 2018 and to 10% in 2019. The HHS notes that “there was a nationwide uptick in the uninsured rate under the Trump administration.”
In 2021, before the American Rescue Plan made premium subsidies larger and more widely available, almost 182,000 Missouri residents were receiving premium subsidies to offset the cost of their individual market health insurance coverage.
The subsidies averaged $553/month, which covered much of the average pre-subsidy premium costs ($639/month). Subsidies are larger now that the American Rescue Plan has been implemented, and are available to some people who didn’t previously qualify for them.
Through the ACA, people with pre-existing conditions no longer face exclusion riders, higher-than-standard rates, or declined applications in the individual market, nor do they face pre-existing condition waiting periods on employer-sponsored health insurance plans.
Cynthia Cox, program director for the ACA at the Kaiser Family Foundation, said “We’re already at peak enrollment.”
“It’s hard to predict how many more people might come in.”
A Kaiser Health News podcast including Cox highlighted several 2022 ACA updates.
-The Biden administration closed the “family glitch” that had prevented many families of low- and moderate-income workers from getting subsidies to purchase insurance on healthcare.gov or state marketplaces.
-States are required to offer “standardized” plans with the same benefits so consumers can better compare them.
-For the first time, people with low incomes (under 150 percent of the federal poverty level) can enroll in ACA plans anytime, instead of only during open enrollment. “This could become particularly important in 2023, as many people are likely to lose their Medicaid coverage when the Biden administration ends the covid-related public health emergency,” according to HealthCare.gov.
-More than 14.5 million people get health insurance through the ACA. The number during the coronavirus pandemic after Congress passed subsidies to make coverage more affordable.
-Most people have three or more options, but about 8% of participants will have only two insurance carriers to choose from.
-According to the Biden administration, 80% of consumers should be able to find a plan for $10 or less a month after tax credits.
Missouri utilizes the federally facilitated marketplace, which means residents enroll through HealthCare.gov (or an approved enhanced direct enrollment entity) if they want a plan through the exchange.
