A 2012 ballot measure preventing Missouri’s government from creating its own health insurance exchange is making state agencies cautious about providing information regarding the coverage options available to uninsured residents this fall.
Proposition E, a ballot measure passed last November, prohibits Gov. Jay Nixon and state health agencies from establishing a state health insurance exchange under the Patient Protection and Affordable Care Act without the consent of voters or lawmakers. Missouri voters approved the measure by 61.7 percent. In part because of the measure’s passing, Missouri is one of 25 other states defaulting to a federally run exchange. Enrollment in the Missouri Health Insurance Exchange is scheduled to open October 1, 2013 and close on March 31, 2014, with coverage starting in January.
These exchanges, or online markets, provide accessible platforms for customers to compare health insurance plans based on factors such as price, benefits and services. However, Ryan Barker, vice president of health policy at the Missouri Foundation for Health, said the vague wording of Proposition E has made agencies cautious about assisting residents or sharing educational materials on the exchange.
“Some of that language is just unclear on what health departments can and can’t do,” Barker said.
Proposition E prevents any “department, agency, instrumentality or political subdivision” from performing the duties of a health care exchange. Among the entities affected is the Missouri Association of Local Public Health Agencies, whose membership comprises 111 regional health departments for counties across the state.
A primary concern of state agencies is that violating Proposition E could potentially open them up to lawsuits, though the terms of the penalty are not explicitly defined. Barker’s worry is that “go-to” rural agencies wary of litigation aren’t able to provide information to residents who need it.
“Consumers have good information, but they can’t access it through their trusted health department,” he said.
Barker said about 877,000 of Missouri’s approximately 6 million residents are uninsured, and the majority of this group would qualify for coverage through the exchange. About half of the state’s uninsured population is eligible for federal subsidies, while between 300,000 and 400,000 individuals are eligible for Medicaid. More residents would qualify for Medicaid, Barker said, had the state legislature not blocked an expansion of the low-income health program in April.
The Missouri Foundation for Health is conducting statewide focus groups to evaluate residents’ awareness of insurance options. Barker said he has witnessed a common theme in the results of these studies: a lack of “insurance literacy,” or familiarity with health insurance terminology. It’s a trend Barker says is especially problematic for residents who have never been insured.
“People don’t even know [the exchange] is an option,” he said. “They don’t understand that there is financial help available.”
Mahree Skala, executive director of the Missouri Association of Local Health Public Agencies, said her organization has advised state agencies to consult with their designated legal counsel on exchange-related matters. However, the legal advice given has differed from agency to agency—though some attorneys have reassured agencies that providing information about the exchange is acceptable, others, such as the legal counsel for Clay County Public Health Center in Liberty, have urged their clients to be more cautious.
“We want to be sure [the agencies] are operating within the parameters of the law,” Skala said.