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Issues: Health Care Insurance for the Poor and Children

The members of the Missouri Union Presbytery surveyed indicated that health insurance for the poor and their children is one of the top issue for the Church and Society Mission Team.


In 2009, The Commonwealth Fund produced a state scorecard that examined health system performance across four dimensions: 1) Access, 2) Prevention & Treatment, 3) Avoidable Hospital Use and Costs, and 4) Healthy Lives.  Overall, Missouri ranked 36th among states across all four dimensions. Missouri’s worst ranking was 41st in the Healthy Lives dimension.

The percentage of uninsured state residents which increased to 827,000 in 2009 played a major role in determining the state ranking in the access dimension.  Nearly 130,000 of those uninsured were children. The growth in the uninsured can be tied to both the decrease in Medicaid coverage in 2005 as well as the decrease in the number of Missourians with employer-sponsored health coverage.

The number of uninsured Missourians contributes to two significant problems in our health care system. First, people tend to delay treatments when they don’t have insurance. This can lead to more serious illness and costly procedures to treat the illness. When uninsured do seek treatment, it is often at the very expensive emergency room which they often have no way to pay. The hospitals and physicians that provide these services treat un-paid bills as an overhead cost that they spread across all the charges to the other patients who do pay. This is cost shifting and increases medical cost to all the insured Missourians.

The problem of uninsured adults is a multifaceted problem involving several financial and health issues affecting the priorities and choices of the individual. Health care coverage for children is affected by the same issues, but the final choice is not made by the child. This problem can only be addressed by addressing the various components like small employer costs, pre-existing conditions, and affordability for individuals. There were several provisions in the health care reform legislation passed in 2009 that address some of these issues. Below is a list of the provisions available to improve health care coverage in Missouri.

Available Health Care Expansions

  • Establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. (Effective  until January 1, 2014)
  • Create a state option to cover childless adults though a Medicaid state plan amendment, beginning in 2010.
  • Provide funding for and expand the role of the Medicaid and CHIP Payment and Access Commission to include assessments of adult services (including those dually eligible for Medicare and Medicaid).
  • Create state based Health Benefit Exchange for individuals and a Small Business Health Options Program (SHOP) for small businesses with less than 100 employees by 2014.
  • Provide oversight of health plans with regard to the new insurance market regulations, consumer protections, rate reviews, solvency, reserve fund requirements, premium taxes, and to define rating areas starting in 2011.
  •  Enroll newly eligible Medicaid beneficiaries into the Medicaid program no later than January 2014 (states have the option to expand enrollment beginning in 2011).

Insurance reforms in 2010

  • Provide dependent coverage for adult children up to age 26 for all individual and group policies.
  • Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prior to 2014, plans may only impose annual limits on coverage as determined by the Secretary. Prohibit insurers from rescinding coverage except in cases of fraud and prohibit pre-existing condition exclusions for children.
  • Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women
  • Establish a process for reviewing increases in health plan premiums and require plans to justify increases.


We believe that it is a priority goal for our State to reduce the number of uninsured children and families. In this period of recession impaired state revenues, the most likely actions will be those to make more affordable health insurance available to employers and the public. The legislation listed below take steps in that direction.

House Bill 609 sponsored by Representative Chris Molendorp  (R 123) creates a quasi governmental organization, governed by a 12 member board, that will operate the Health Benefit Exchange for individuals and a Small Business Health Options Program (SHOP) for small businesses identified in the expansion list above. This measure was introduced February 23rd and awaits further action.