In the wake of the Supreme Court decision Thursday to uphold subsidies for health insurance purchased through federal marketplaces, Missouri advocates for health care for the poor celebrated the decision, but one of the state’s leading business lobbies expressed concern.
Ryan Barker, vice president of health policy at the Missouri Foundation for Health, welcomed the news that the nearly 200,000 people in Missouri who were at the risk of losing their subsidies will continue receiving them.
“We are very pleased with the Supreme Court’s ruling,” Barker said.
Sidney Watson, a professor at the St. Louis University School of Law who specializes in health policy and health care access for the poor, agreed with the court’s 6-3 decision that neutralized another threat to President Barack Obama’s health care law.
“It should be good news for Missouri businesses, and particularly small businesses,” Watson said, “because many of them encouraged their employees to use the marketplace and take advantage of the premium tax discounts.”
However, Ray McCarty, the president and CEO of business lobby Associated Industries of Missouri, said the health care law adds pressure for business owners. Specific taxes levied on health insurance companies are passed onto businesses that buy insurance to their employees, McCarty said.
“It’s unfortunate from the aspect that we’ll continue to, I believe, take down the individual insurance companies in America,” he said.
McCarty also questioned the validity of allowing nationwide subsidies, which was the issue at the center of the Supreme Court case.
“I believe that the court decided this issue more on political grounds than on legal ones,” McCarty said. “The plans must be set up by the states. The court seemed to ignore that and looked more at the policy implications of what they were deciding, rather than looking at the strict rule of the law.”
Addressing the Medicaid gap
Although Thursday’s ruling saved subsidies — and, presumably, the ability to afford insurance — for 197,663 Missourians, there are still tens of thousands of people in the state who fall into what a Kaiser Family Foundation report calls “the Medicaid gap.” Those people have income above the maximum level to qualify for Medicaid but below the minimum for Marketplace premium tax credit eligibility. As of 2014, there were 147,000 Missourians in that group, according to the Kaiser report.
Primaris, an insurance consulting firm in Columbia, joined the Affordable Care Act navigator program in 2014. Through the program, Primaris educates and counsels people about their insurance coverage options and how the health care law affects their budget.
“If you are under the poverty level, and not eligible for the Medicaid, which in Missouri is fairly strict, and you are too poor to buy insurance on the marketplace, we say these people fall into the Medicaid gap,” Milarsky said.
The president’s health care law attempts to address that gap, calling for the expansion of Medicaid eligibility to include people making up to 138 percent of the federal poverty level. But the Missouri Legislature has continually refused to expand the program as mandated by the Affordable Care Act.
“We would agree with Gov. Nixon that Medicaid should be expanded,” McCarty said. “But it is very important also that they should use it as an opportunity to reform Medicaid, and make sure that we provide Medicaid to those of real demands but not into fraud and abuse cases.”