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The State of ACA in the State of Missouri Nazarina V. Mwakasege-Minaya, MSW Candidate – April 13, 2015

Introduction

The Patient Protection and Affordable Care Act was signed into law five years ago on March 23, 2010 in hopes of expanding health care coverage to the majority of Americans through state and federal heath marketplace exchanges. 1 Missouri was one of the 27 states that did not opt to expand Medicaid. Instead, residents were invited to utilize the federally-facilitated exchange or FFE (FFM). When this occurs either the state or the federally government itself may perform functions such as reinsurance or determining eligibility for federal health care programs. 2

Overview of Missouri 2

A Quick Look at Missouri 2

Health Status Indicators 2

Health Service Indicators for Older Adults 2

Overview of Implementation of Health Care Reform in Missouri

Prevention and Public Health Fund (PPHF)6

Innovation Spotlight7

Potential Impact of Supreme Court Decision on Marketplace Subsidies8

Since 2010, Missouri has received over $12.5 million from the prevention fund. Missouri has been conscious of the issues they must tackle in terms of their population’s health. Their initiatives focus on two of their most poignant issues, given the information in the aforementioned tables, their high death rates, especially amongst teenagers, and their low immunization rates of children. $3.4 million has been put toward Community Transformation Grants or CTGs meant to address the leading chronic diseases and causes of death amongst Missourians.   $4.2 million has been put forth to improve access to vaccines, in both availability and the implementation for a plan to bill for immunization services for insured persons.

•  Home to 2% of the US Population •  99% of the population are American Citizens

•  More than 50% of the population is between 200% - 400%+ the Federal Poverty Level

•  Only 6% of Adults over the age of 65 live in poverty

as compared to the US’ 10%

For all ethnicities in which there is sufficient data, Infant Mortality in Missouri is higher, on average, than in the United States overall. The teen death rate here is much higher than the average in the US where 45 per 100,000 die, Missouri is at 67 per 100,000. This is striking in light of recent events.

Health Insurance Coverage of Total Population 2

Persons ages 0-64 do not fare as well. Less children have preventive medical/dental visits in a year and less than average get vaccinated between 19-35 months than the country’s average. Adults also receive less dental care in 12 months time.

•  Even though Missouri has not opted to expand Medicaid, the governor, Jay Nixon, has included the Medicaid expansion in the state’s budget for FY 2016.3

•  Between FY 2010 to FY 2014, Missouri has received more than $334, 000, 000 in ACA grant funding. 4

•  Almost half of these funds have gone toward various health care centers to make readily available more doctors, and facilities with longer hours.5

Forms of preventive care like vaccinations for flu and pneumonia is high amongst older adults, who also tend to have higher rates of health care coverage and lower rates of poverty.

Health Service Indicators for Younger Adults and Children2

Center for State Health Policy Project: Sustainable High-Utilization Model Cost: $14, 347, 808 Proposed Savings: $67, 719, 052 Purpose: To test and increase increase a care management method for low-income populations with high need and services are usually high-cost served by safety-net provider organization in Kansas City, Missouri and other, similar American cities. The model utilizes nurses, social workers and community health workers to provide patient-centered support that address not only health care needs, but underlying determinants of health.

•  370,065 will lose their health care coverage •  An average of $3, 370 loss per person in tax credits.

Pot ent al Impact of Congressional Appeal on Women9,10 • More than 122, 000 women would lose out on health credits that pay their insurance premiums. • These premiums provide for primary care visits, mammograms, birth control and a host of other services that allow them to live healthier lives.

Recommendations11,12

References

• Expand Medicaid and allow the state to save over $81 million per year. • Expanding Medicaid will benefit children/teens .Studies have shown that children who are eligible for coverage are 3x more likely to enroll and much more likely to stay enrolled if their parents also have insurance. • Finally, covering parents protects the family from financial distress in case of a medical emergency.

1. Kff.org. Summary of the Affordable Care Act. 2013. Available at: http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/. Accessed April 13, 2015. 2. Kaiser Family Foundation. State Health Facts. 2015. Available at: http://kff.org/state-category. Accessed April 13, 2015. 3. Kff.org. Status of State Action on the Medicaid Expansion Decision. 2015. Available at: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/. Accessed April 11, 2015. 4. Center for Healthcare Research & Transformation. ACA Grant Funding By State FY 2010 - FY 2014.; 2015. Available at: http://www.chrt.org/wp-content/uploads/2015/02/app2-.jpg. Accessed April 12, 2015. 5. Hhs.gov. 5 Years Later: How the Affordable Care Act is Working for Missouri | HHS.gov/healthcare. 2015. Available at: http://www.hhs.gov/healthcare/facts/bystate/mo.html. Accessed April 11, 2015. 6. The Prevention And Public Health Fund At Work In Missouri. 1st ed. Washington, D.C.; 2014. Available at: http://healthyamericans.org/health-issues/wp-content/uploads/2015/01/MO-Fund-at-Work.pdf. Accessed April 11, 2015. 7. Innovation.cms.gov. Health Care Innovation Awards: Missouri | Center for Medicare & Medicaid Innovation. 2015. Available at: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Missouri.html. Accessed April 11, 2015. 8. Blumberg L, Buettgens M, Holahan J. The Implications Of A Supreme Court Finding For The Plaintiff In King Vs. Burwell: 8.2 Million More Uninsured And 35% Higher Premiums. Washington, D.C.: Urban Institute; 2015. Available at: http://www.urban.org/UploadedPDF/2000062-The-Implications-King-vs-Burwell.pdf. Accessed April 12, 2015. 9. Planned Parenthood. How King V. Burwell Could Wipe Out Insurance Coverage For 4.1 Million Women.; 2015. Available at: http://www.plannedparenthood.org/files/9514/2540/0438/KingvBurwell_WhitePaper_Mar032015.pdf. Accessed April 12, 2015. 10. Pugh T. Big impact on women if Supreme Court rules against health care tax credits.McClatchy DC. http://www.mcclatchydc.com/2015/04/06/262222/big-impact-on-women-if-supreme.html. Published 2015. Accessed April 12, 2015. 11. Missouri Budget Project. Medicaid Makes (Dollars &) Sense. St. Louis,; 2015. Available at: http://www.mobudget.org/wp-content/uploads/2015/01/Medicaid_Dollars_Sense_2015.pdf. Accessed April 12, 2015. 12. Expand Medicaid In Missouri. 1st ed. Missouri Medicaid Coalition; 2015. Available at: http://www.momedicaidcoalition.org/factsheet.pdf. Accessed April 13, 2015.