Supreme Court's ruling relieved millions of Missourians financial burden on health insurance

The Supreme Court’s ruling saved millions of people in Missouri from spending more money on their health insurance.

President Obama claimed a victory after the Supreme Court upheld the Affordable Care Act on June 25. This ensured millions of poor and middle-class people in states with federal-regulated health market will continue receiving subsidies to pay for their health insurance. As one of the federally facilitated marketplaces, Missouri benefits a lot from this ruling.

“Missouri did not establish its own exchanges,” said Karen Edison, the founder of the Center for Health Policy. “But we have a great achievement in terms of the proportion of population who enrolled or re-enrolled in the marketplace.”

According to the data from U.S. Department of Health and Human Service, the number of people who enrolled in Affordable Care Act in Missouri is 219,953. Almost 90 percent of them enrolled with subsidy, and each of them receive a subsidy of $3,336 every year.

This means the ruling had an estimated 198,000 people in Missouri avoid a boost of their cost of health insurance.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Chief Justice John Roberts said in the decision document.

However, some questions still remain. The biggest one is whether the law is making health care truly affordable for most citizens.

Who has access to the subsidies?

The subsidies are used to help people who could not afford health insurance on their own.

Under the Act, people whose income is between 100 percent and 400 percent of the federal poverty level may be eligible for premium tax credits. The number of tax credits usually determines how much subsidies or discounts a person can get. Other factors include one’s state of residence, age, income and family size.

According to the March 11, 2014, report from U.S. Department of Health and Human Services, about 170,000 Missouri residents who are eligible for a marketplace plan tried to enroll, but less than half of them succeeded.

Stephene Moore, regional director of Health and Human Services, told Missourian that it always took a while for the public to understand a major policy change.

The result of a poll held in January by Kaiser Health showed that 44 percent of the public still did not understand the Affordable Care Act and how it will impact their lives.

Edison also agreed that there is misinformation about the Act.

“If you ask people ‘what do you think of Obamacare’, most of them would say ‘I hate it’.” Edison said.

“But if you ask them ‘what do you think of keeping kids under parents’ insurance until 26, making the insurance companies not have lifetime limits, expanding coverage to the lower-income population.’

“You like all these? That’s Obamacare.”

In Boone County, Anthem BlueCross BlueShield and Coventry Health Care are the two main insurance providers.

They offer 18 plans in total. The plans are categorized by bronze, silver and gold level. A more expensive plan usually has a bigger physician network. But all of them cover the same 10 essential health benefits, such as emergency services, hospitalization, and prescription drugs.

Future changes of the insurance companies

Overall, the insurance industry is expecting three trends after the Supreme Court’s ruling.

First of all, insurance companies tend to merge.

Health insurer Aetna announced that it had agreed to acquire its smaller rival Humana for $37 billion in cash and stock on July 3. Anthem also reiterated its commitment to proposal to acquire Cigna Corporation for $184 per share in cash and stock on June 22.

According to Deb Wiethop, the public relations director of Anthem BlueCross and BlueShield in Missouri, Anthem’s health plans provide coverage to more than 800,000 individuals via online marketplaces. With the consolidation, Anthem could be more competitive to maintain and expand its coverage in Missouri and the nation.

Second, the insurance rates might rise.

There are eight carriers in the Missouri exchange, and only three of them, BlueCross BlueShield, Coventry and Humana, have proposed double-digit rate increases for 2016.

Missouri was one of the five states where the rates review process for ACA-compliant plans is conducted solely by U.S. Department of Health and Human Services.

After Consumers Council sued the Health and Human Services last September, Health and Human Services’ agreed to release proposed rate increases. Missouri consumers can get to know proposed health insurance premium increases of 10 percent or more for the first time on June 1.

However, this might not have a large impact on protecting premiums from increasing, CEO of Central Missouri Area Agency on Aging Jean Leonatti told Columbia Daily Tribune. The Act gives the government the authority to review rates but not to control them.

Third, there might be more competition in 2015.

In Missouri, the number of insurers offering policies through HealthCare.gov increased from four in 2014 to eight in 2015.

The ruling for Affordable Care Act showed possible profits in future. More than 16 million Americans have obtained insurance because of the Act, but there are still more than 10 percent of Americans lacking insurance. This indicates plenty of room for growth and competition.

The ruling might bring more stability to the local hospitals

Most hospitals in Missouri accept insurances from the Affordable Care Act. The ruling reassured patients can use their health insurances without too much concerns, and this helps the hospitals improve their health situations more efficiently.

Steve Lipstein, the president of BJC HealthCare, wrote in his public statement that the Act would continue bringing greater stability and predictability to the health care industry.

“The more patients have insurances, the more stable the health system will be,” said Rebecca McClanahan, President of the Missouri Nurses Association. “So the hospitals can maintain enough health services and decrease layoff.”

Family Health Center, which is within both Anthem BlueCross BlueShield and Coventry Health Care’s network, also accepts uninsured and low-income patients.

“We are approved and funded by the federal government to provide access for those who don’t have health insurances,” said Emily Clapper, the outreach specialist of Family Health Center. “They only need to pay 20 to 80 dollars for primarily and common diseases.”

However, the faculty at the Center is still trying to encourage people to buy insurances under the law. One reason is that the Center can only deal with a limited number of patients without insurances per month. The other reason is that patients without insurances tend to put down their diseases or injures, but this would only lead to more serious health conditions.

“It’s a great thing that the Supreme Court’s ruling made sure that people can continue using their health insurance,” Clapper said. “But we also have to admit that there are still a number of people who can’t get any health insurance at all, and there is a coverage gap we have to deal with.”

The next fight: Medicaid expansion

The Supreme Court’s ruling got a lot of applause, but Edison said she believed this is only a starting point to provide accessible and affordable health care for every citizen in America.

“For now, only people whose incomes between 100 percent and 400 percent of the federal poverty level may be eligible for Obamacare,” Edison said. “There are still a lot of people underserved, especially African Americans and Hispanic people.”

“Almost 300,000 Missourians are out of the system.” McClanahan said. “They work too much to be qualified for Medicaid, but they do not make enough money to buy health insurances and get subsidies.”

A lot of organizations are signing up for a Medicaid expansion plan on covermissouri.com, but the Missouri state government has not shown any interest in it. The future fight for Missouri residents might be a fight for minimizing the coverage gap and providing equal access to health care.