Open enrollment begins on November 1, for coverage effective January 1, 2016. Missouri residents have eight carriers from which to choose in the exchange, but there is still no realistic option for adults with income under the poverty level, as Missouri has not yet accepted federal funds to expand Medicaid.
Looking ahead to 2016
There are eight carriers in the Missouri exchange, and only three of them (Blue Cross Blue Shield of Kansas City, Coventry, and Humana) have proposed double digit rate increases for 2016. Healthcare.gov’s rate review tool only displays proposed rate increases if they are ten percent or higher, and rate filings for most of Missouri’s carriers are not included on the list. There are a couple other ACA-compliant plans in the state that have proposed rate hikes of ten percent or more, but they’re for plans that are only sold outside the exchange.
Across the entire ACA-compliant individual market in Missouri – including off-exchange plans – ACAsignups puts the proposed weighted average rate increase somewhere in the 12 to 15 percent range. But we won’t know the final numbers until they’re published on Healthcare.gov sometime in October.
Missouri is one of only five states where the rate review process for ACA-compliant plans is conducted solely by HHS; state regulators do not take an active role in reviewing and approving (or denying) proposed rates. HHS will continue to review rate proposals over the summer, and finalized rates will be available in advance of open enrollment, which starts this year on November first, for coverage effective January 1, 2016.
More than 253,000 Missouri residents enrolled in private health insurance through HealthCare.gov during 2015 open enrollment. About 52 percent of enrollees were first-time shoppers on the marketplace. In 2014, about 152,000 Missourians purchased insurance through the exchange.
In July, HHS released county-level enrollment data for all 37 states that use Healthcare.gov. Missouri’s enrollment totals for each county can be seen by hovering over the counties on the interactive map.
Some enrollees didn’t pay their initial premiums, and others cancelled their coverage or it was eliminated due to lack of documentation on immigration status. By the end of June, 212,256 people in Missouri had effectuated private-plan coverage through the exchange. 89 percent of them are receiving premiums subsidies, which average $278 per month, and reduce average premium payments from $363 to $85 per month.
Subsidies safe in Missouri
The continued availability of subsidies in Missouri was uncertain for the first half of 2015, because the state uses the federally-run exchange. The King v. Burwell lawsuit challenged the legality of subsidies in the federally-run exchange, with plaintiffs claiming that subsidies could only be provided by state-run exchanges. But on June 25, the Supreme Court ruled that subsidies are legal in every state, which means that 189,000 people in Missouri are no longer in danger of losing their premium subsidies, and their premiums are not increasing by 327 percent – which would have been the case if subsidies had been eliminated.
It also means that the individual market will remain stable, which would not have been the case if subsidies had been eliminated. Many people who aren’t currently receiving subsidies would have been priced out of the insurance market if subsidies had been eliminated. The Urban Institute had projected a 55 percent spike in premiums (in addition to regular annual rate increases) for people who currently pay full price for their coverage. They also predicted that the overall individual market risk pool size would have dropped by 70 percent if the Supreme Court had struck down the subsidies. Fortunately for the residents, medical providers, and insurers in Missouri, that didn’t happen.
Did you miss open enrollment?
While open enrollment for 2015 is over, you can still sign up for coverage under certain conditions.
- If you experience a qualifying life event, you can sign up for coverage during a 60-day special enrollment period.
- If you are a Native American or Alaska Native, you can enroll any time during the year.
- If you qualify for Medicaid, you can apply any time during the year.
Open enrollment for 2016 will start on November 1, 2015, and will continue through January 31.
More competition in 2015
Missouri was part of a national trend of expanded competition on the health insurance marketplace for 2015. The number of insurers offering policies in Missouri through HealthCare.gov doubled — going from four in 2014 to eight in 2015. Dan Mendelson, CEO of Avalere Health, told CNBC the growing participation by insurers is good news for consumers: “The exchanges are a robust commercial market — viable in the short run and very strategic for a future that has more individual choice.”
Missouri small businesses (those with 50 or fewer employees) can shop for health insurance through HealthCare.gov year-round. Starting in 2016, the SHOP exchange will be open to businesses with up to 100 employees.
Starting with the 2015 coverage year, Missouri’s small employers can offer their employees a choice of several health plans within a single metal level through the SHOP’s “employee choice” option. Missouri was among 14 states using the federal exchange to implement employee choice starting in 2015.
How many people enrolled in 2014?
More than 152,000 Missourians purchased health insurance through the marketplace during 2014 open enrollment. That’s 23.2 percent of the estimated eligible market according to the Kaiser Family Foundation. The national average was 28 percent.
In addition to those purchasing private insurance plans, 45,513 people qualified for either Medicaid or the Children’s Health Insurance Program (CHIP).
Among Missouri residents who purchased health insurance, 85 percent qualified for financial assistance, which matches the national figure. A report released in June by HHS showed the average monthly premium, after tax credits, for Missouri consumers was $59. Fifty-seven percent of enrollees paid $50 or less per month after subsidies.
Twenty-one percent of Missouri residents selected a bronze plan (20 percent nationally), 63 percent selected a silver plan (65 percent nationally), 13 percent selected a gold plan (9 percent nationally), 0 percent selected a platinum plan (5 percent nationally) and 3 percent selected a catastrophic plan (2 percent nationally). Twenty-nine percent of Missouri enrollees were between the ages of 18 and 34.
Overcoming legislative roadblocks
Many Missouri legislators have steadfastly fought against the Affordable Care Act and implementation of the health insurance marketplace.
Legislation to establish an exchange was introduced but failed to pass in both 2011 and 2012. Despite the lack of legislative authorization, some initial workgroups were established. In 2011, Gov. Jay Nixon established the Health Insurance Exchange Coordinating Council, which did some initial scoping and planning. Also in 2011, the Senate created the Interim Committee on Health Insurance Exchanges to explore Missouri’s options to establish a state-based exchange.
Members of the Interim Senate committee refused to authorize the use of federal grant money. In April 2012, the Missouri legislature rejected a $50 million grant to upgrade the state’s Medicaid information system as some legislators believed the system would be used as a springboard to building a state-run exchange.
In May 2012, the Missouri legislature approved a ballot measure to prevent the executive branch from authorizing a state-based health insurance exchange without legislative or popular approval — even though Gov. Nixon repeatedly stated his administration would not authorize an exchange by executive order. Voters passed the ballot measure in November 2012, and state defaulted to the federally operated exchange.
Missouri initially required training and licensing for navigators that went far beyond federal standards. Legislation also prohibits navigators from providing “advice concerning the benefits, terms and features of a particular health plan, or offer advice about which exchange health plan is better or worse for a particular individual or employer.” Several health care advocacy groups challenged the restriction on providing advice, saying that is the core function of navigators. In January 2014, a federal judge agreed and issued an injunction to halt enforcement of the law. And in April 2015, a federal appeals court concurred, ruling that Missouri could not restrict navigators from helping people enroll in plans through Heathcare.gov.
In January 2015, Republican Sen. Bob Onder filed a bill that he says is aimed at blocking the Affordable Care Act’s individual mandate. SB 51 would revoke a health insurance company’s license to sell policies in Missouri if it accepts federal subsidies for policies sold through the federal marketplace. It’s questionable what impact the bill would have if it were to pass. One legal expert told the St. Louis Post-Dispatch, “It’s sort of an exercise in futility.” Ultimately, the bill didn’t advance out of committee.
Missouri health insurance exchange links
State Exchange Profile: Missouri
The Henry J. Kaiser Family Foundation overview of Missouri’s progress toward creating a state health insurance exchange.
Missouri Department of Insurance
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(800) 726-7390 / email@example.com