For Missourians, geography and health go hand in hand. The Show Me State reports improvements to its population’s health over time; however, the inequality between those living rural and urban remains a constant. Disparities in Missouri health insurance access and its available healthcare resources contrast sharply between the two populations.
Since the Affordable Care Act took effect, the state has seen uninsured rates drop to 9% (on par with the national average) and it is tied with 10 other states for the 14th highest uninsured population.
When it comes to affordable health insurance, residents of Missouri have options. They can choose to enroll in major medical plans available through the state’s federally facilitated exchange or the private market. They may also consider short term medical health insurance plans, which can provide a budget-friendly healthcare alternative for those who can’t afford major medical insurance or don’t qualify for Medicaid.
Health Insurance Alternatives in Missouri
Short term health insurance, which is sometimes called short term medical insurance, temporary health insurance, or short term limited duration insurance, is not available in every state. However, it is an option to people who live in Missouri who want an alternative to major medical insurance or who need temporary benefits due to circumstances such as divorce, termination from a job with benefits, or turning 26 and aging off of a parent’s health insurance plan. It may also be a health care coverage solution for those who are in an employer waiting period for benefits.
Short term plans include benefits for physician visits, in-hospital care, urgent care facility visits and much more. Oftentimes, they do not include medical network restrictions, allowing you to choose which healthcare providers and hospitals you utilize. All of Pivot Health’s short term health insurance plans come with a non-insurance discount prescription drug card, and you also have the option to select short term plans with prescription drug coverage.
Short term health insurance is available year-round—no open enrollment periods. You will know if you are approved for the plan before applying so your time isn’t wasted on coverage that you might not be eligible for. You can then choose a coverage effective date within 24 hours of your online application or up to 60 days in the future.
While some states allow short term health insurance policies up to 364 days, Missouri state law limits short term health insurance policies to 180 days with the ability to reapply for additional policies up to 36 months.
ACA Plans + Medicaid
Missouri’s health insurance exchange is federally facilitated, which means Missourians use HealthCare.gov to enroll in individual major medical insurance plans.
Four insurers offered individual health insurance plans through Missouri’s exchange in 2019, a number that matched the national average. However, insurer and plan options vary by county, and Missouri counties had access to plans from a single carrier.
The Cover Missouri Coalition provides an online resource for Missourians who need to find local help and information related to health insurance enrollment for individual and family plans.
Under the Affordable Care Act, many states elected to expand Medicaid eligibility to those with incomes up to 138% of the federal poverty level. Missouri is one of 14 states that has not adopted the expansion. If Missouri were to expand Medicaid, an estimated 95,000 individuals may be eligible to enroll in coverage, according to the Kaiser Family Foundation.
Missouri’s Medicaid program is known as MO HealthNet. If you live in Missouri and want to enroll in MO HealthNet, you must meet eligibility requirements.
The State of MO Healthcare
As mentioned above, healthcare disparities are stark between Missouri’s rural and urban populations. The Missouri Department of Health and Senior Services’ biennial report, Health in Rural Missouri, details the issue. Two key areas include disparities in deaths from a range of conditions and access to healthcare.
Disparities in life expectancy along with deaths from heart disease, cancer, chronic lower respiratory disease, stroke, unintentional injuries, motor vehicle accidents and other conditions are statistically significant between the two populations.
Furthermore, rural Missourians experience limited access to the resources necessary to maintain health and prevent and treat disease, regardless of their health insurance status, financial situation and access to transportation.
Missouri tends to struggle in national health and healthcare rankings, and these disparities are a factor. Most recently, the state ranked 43rd out of 51, including the District of Columbia, in The Commonwealth Fund’s 2019 Scorecard on State Health System Performance.
On the Scorecard, Missouri placed 51 out of 51 for disparities based on income, performing poorly across 19 indicators related to access and affordability, prevention and treatment, potentially avoidable hospital use and cost, and healthy lives.
Two areas in which Missouri showed improvement included childhood obesity and adult access to mental health treatment, as reported by the Springfield News-Leader. The president and CEO of the Missouri Foundation for Health suggested progress for adult access to mental health treatment could possibly be due to Missouri’s participation in the Excellence in Mental Health Act. The Excellence in Mental Health and Addiction Treatment Expansion Act expands access to community mental health services; Missouri and five other states are involved with the pilot program.
Access Concerns in Rural Populations
The disparity in access to healthcare between rural and urban areas has become an increasing concern for Missouri’s residents and lawmakers. In recent years, the state’s rural areas have seen an uptick in hospital closures along with a decline in licensed physicians.
Missouri’s population is 37% rural, yet only 9% of physicians licensed in the state practice in rural areas—and their numbers are decreasing. The number of physicians serving rural Missourians declined by 15% since 2011, according to 2014 Hospital Industry Data Institute statistics. Of Missouri’s 101 rural counties, 99 are considered Health Professional Shortage Areas (HSPAs), 97 are Mental Health HSPAS and 95 are dental HSPAs.
The state experienced six rural hospital closures over the last five years—three of them between 2018 and 2019—according to data from The Cecil G. Sheps Center for Health Services Research at the University of North Carolina Chapel Hill. Diminishing access to nearby emergency can have dire consequences as the time and distance traveled to receive treatment for severe illnesses and injuries increases.
The Columbia Missourian recently reported in-depth on this issue and its impact, stating:
The status of health care in rural parts of Missouri paints a bleak picture for farmers who live and work in such a dangerous profession. On top of working under constant risk of injury and death, farmers have very few options when it comes to the types of care they can receive. And, when and if that care is available, patients can be billed exorbitant costs.
To address healthcare disparities and challenges rural Missourians face, the Missouri Department of Health and Senior Services Office of Primary Care and Rural Health recommends that “state regulations and policies continue to consider the varying degrees of difference between urban and rural areas/residents,” and points out that with the unique challenges each population faces, what is good for hospitals and healthcare providers in large urban areas may not be good for small rural hospitals and healthcare providers.
Of course, neither rural hospital closures nor physician shortages are unique to the state of Missouri. The U.S. currently faces a nationwide physician shortage that disproportionately impacts rural communities. In recent years, the U.S. has also seen a significant uptick in rural hospital closures; it’s a trend expected to continue, according to a Kaiser Family Foundation study of rural hospital closures.
Healthcare Hot Topics + Legislation
Missouri continues to be part of the national conversation around healthcare, appearing in news stories related to a range of issues related to mental health, medical marijuana, women’s health, and the opioid epidemic.
A substantial increase in the number of Missouri children who had thoughts of suicide or attempted it drew national concern in April 2019 following a study released by the Missouri Hospital Association, which examined the impact of the state’s decision to shift thousands of low-income children from traditional fee-for-service Medicaid to managed care in 2017. The study drew criticism from the Missouri Health Plan Association, which also said was taking the findings “very seriously,” according to the St. Louis Post-Dispatch.
In other news related to mental health, Missouri Rep. Jim Neely, R-Cameron, in April 2019 introduced a bipartisan bill that would allow mental health patients to seek care without prior authorization. The bill, HB 653, failed on May 17, 2019.
Missouri voted to legalize medicinal marijuana on Nov. 6, 2018, making it the 33rd state to do so. Final rules took effect June 3, 2019, and the certification began June 4. The state’s Department of Health and Senior Services starts accepting patient applications on June 28.
However, many news outlets have reported that patients looking to get certified for use are running into resistance from doctors. The state’s physicians’ lobby Missouri Medical Association opposed the ballot initiative voters approved in November, according to Insurance Journal; some suspect the reluctance comes from lack of information, lack of federally approved standard dosages or safety testing, no insurance coverage, and the fact that the federal government still considers marijuana an illegal drug.
Missouri residents who want to get certified may instead turn to specialty and pop-up clinics or independent physicians, as patients in other states have done.
Missouri is one of six states with a single abortion clinic, and that clinic faces closure as the state’s health department refuses to renew its license. However, the St. Louis Planned Parenthood clinic remained open after receiving permission from a court to continue practicing until June 28, 2019, allowing time for an administrative panel to evaluate the dispute between the clinic and the state’s Department of Health and Senior Services.
In Missouri, opioid deaths have been more than twice the national rate, with rural rates 21% lower than the national average and urban rates 18% higher than the state average and 37% higher than the national average. The DHSS states that combating this crisis is a top priority, and in June 2018 the department, along with others, reported that opioid death rates decreased from 2016 to 2017.
DHSS listed trying to decrease the potential for people to become addicted to opioids as one of the most significant efforts it has undertaken. The department has been analyzing prescriber data, which is voluntarily provided and doesn’t include patient information, and then using that data to take action and investigate improper prescription behavior through its Bureau of Narcotics and Dangerous Drugs.
One challenge Missouri faces in this fight is the fact that it has no statewide prescription drug monitoring program—for seven years in a row, it has been the only state without one. The bill has been introduced annually in the Missouri legislature since 2005, according to Kaiser Health News, but it hasn’t been able to get a full senate vote due to a number of concerns around privacy and how providing personal information to the government could lead to fewer personal liberties, including the right to bear arms.
In the meantime, the voluntary database covers 84% of the state’s populations, according to Kaiser. By many accounts, it has been effective in discouraging pill shopping.
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