Get Past Missouri Legislature’s Healthcare Roadblocks

St. Louis Post-Dispatch, October 9, 2013

By Joan Bray, Executive Director of Consumers Council of Missouri

Nearly 500,000 uninsured Missourians got the opportunity, beginning last week, to do something extraordinary — get health insurance through the Affordable Care Act. Now they can add security and comfort to their lives, knowing they finally have medical care they can afford.

And they will get it at reasonable cost because individuals and families earning incomes up to 400 percent of poverty will be assisted by subsidies or tax credits. Consumers can go to, click through to Missouri, choose from among 17 insurance plans and determine the cost to their budgets.

Unfortunately, opponents of the ACA in Missouri’s Legislature have spent the past three years obstructing this opportunity.

In August 2010, the Legislature put Proposition C on the ballot, aimed at Missourians opting out of a major requirement of the federal law — obtain insurance or pay a penalty. The measure passed, but the outcome was only symbolic because federal law generally trumps state law. The result serves primarily to cloud the atmosphere.

In November 2012, Proposition E became law, largely barring state workers from assisting Missourians in taking advantage of the ACA and making them liable for lawsuits if they do. The federal law establishes a marketplace in each state, an online destination where consumers compare insurance options in plain language. Prop E decreed that no state employee may participate in designing or implementing the marketplace unless it has been established in Missouri law — which the Legislature refused to do.

As a result, nonprofit organizations such as the Missouri Foundation for Health and the Missouri Hospital Association are picking up the slack to provide enrollment assistance. They know that healthier Missourians are more productive and happier Missourians.

As if lawmakers hadn’t done enough damage through ballot measures, this past legislative session they passed another attempt to safeguard the state’s dubious distinctions of ranking 42nd in health status among the states and having the second-highest growth rate of uninsured people over the past 13 years.

The ACA provides for people and organizations, “navigators,” to help consumers choose and enroll in insurance plans. It makes sense. Selecting insurance is stressful, even for those who enroll annually under employer plans.

But Senate Bill 262 makes it difficult for navigators to function. The Missouri law:

• Imposes a fine on anyone who is unlicensed as a navigator but is helping someone find insurance in the marketplace. It requires private individuals who talk to other private individuals about insurance to either obtain a navigator license or pay a fine. This has a chilling effect on community and public interest organizations that are filling the gap in state involvement caused by Prop E.

• Bars navigators from providing advice about “the benefits, terms, and features” of a plan. So much for navigators being helpful. Such language prevents navigators from meeting the federal law’s requirements to “distribute fair and impartial information concerning enrollment in qualified health plans” and “facilitate selection of a qualified health plan.” But Missouri keeps a navigator from advising a consumer that one plan is better than another and disclosing plan details.

• Doesn’t allow navigators to tell consumers about plans or other insurance products not offered in the marketplace. Qualified health plans will also be sold outside the marketplace. But a navigator in Missouri has to pretend they don’t exist.

• Mandates that a navigator encountering a person who has insurance obtained from an insurance agent not advise that person but refer her instead to the private market.

A majority of the highly partisan Missouri Legislature has made the ACA much less attainable for the people they are sworn to serve, 13 percent of whom are uninsured. These lawmakers have spent the past three years demonizing and complicating the most socially beneficial federal legislation since Congress passed Medicare and Medicaid in 1965.

Missourians must draw on our deep-seated Midwestern grit and perseverance to get past the negative rhetoric and destructive policies calculated to diminish us before we can finally provide a healthier, happier future for ourselves and our families. We can do it.

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