The State of Health Care in our State

By Kjersti McDonald

I’m going on two years as a community organizer for a non-partisan, non-profit grassroots health care advocacy organization in Missouri, and as such, I can definitively say: the state of health care in Missouri is abysmal.

If you’re reading this, there’s a good chance you’re either uninsured or under-insured, meaning your premiums, copays and deductibles are too expensive and/or your plan doesn’t offer adequate coverage. If you fit into the former, you are part of roughly 500,000 – that’s half a million – Missourians who are also uninsured.

Missouri’s health care system ranks 43rd in the country.

Medicaid is a state program that provides health insurance to children, disabled and elderly adults, and extremely low-income parents.

Unfortunately, Missouri has one of the strictest eligibility requirements for adults to qualify for Medicaid. In order to qualify for Medicaid services as a non-disabled, non-elderly adult, you have to 1) have kids (childless non-disabled adults are disqualified, no matter how poor) and 2) have an income lower than 22% of the federal poverty level (FPL). (Curious about where you fit into the federal poverty scale? Enter your family size and income in the calculator here.)

To put that income limit into perspective, it means the parents of a family of three cannot take in a combined monthly income of more than $390 and still qualify for Medicaid.

Who is living off $390 a month??

Any adult who makes more than 22% FPL, or just doesn’t have children, but doesn’t have enough to get subsidies for health care plans on the ACA Marketplace, falls into what is called the Coverage Gap. No way to qualify for Medicaid, but no conceivable way to afford private insurance.


What doesn’t make sense is the fact that Missouri had the chance to close the Coverage Gap and expand Medicaid to cover childless adults making up to 133% of the federal poverty level – just under $16,000 a year for an individual – with 100% of the costs being covered by the federal government… and our legislature turned it down.

The opportunity for this all-expenses-paid expansion came with the passage of the Affordable Care Act – a piece of legislation that admittedly has flaws, but has increased the number of insured people in the U.S. by 20 million.

As it stands, Missouri is one of 14 states that have yet to expand Medicaid with the help of the federal government. Since we’ve waited so long, Missouri would be responsible for 10% of the costs of expanding Medicaid, while the federal government would still cover 90%.

What would it look like if we expanded Medicaid to include childless adults up to 133% of the federal poverty level? It’s estimated that 200,000 to 300,000 Missourians would automatically qualify and could apply for Medicaid.

Think of all the service-industry workers, students whose parents don’t have insurance for them to stay on, and low-income parents who would be able to visit a doctor, receive mental health care, and have the peace of mind that comes with knowing that if something traumatic were to happen, they wouldn’t be faced with outrageous hospital bills and bankruptcy!


As you can see on the map above, SWMO is among the regions whose populations would benefit the most from expanding Medicaid.

Opponents of expanding Medicaid in Missouri say our state couldn’t handle the 10% cost of covering a much bigger population. However, a Washington University study shows that the possible savings our state could experience would far outweigh the possible increased costs. This is because currently, the federal government only helps with 65% of the costs of running Medicaid, and there are many programs that would fall under the umbrella of federal funding through Medicaid expansion that the state is currently covering on its own.

It seems like an obvious solution (albeit relatively small in scale and short-term) to the health care crises that is plaguing our country and our state. A quarter-million people gaining health insurance is nothing to scoff at.

Expanding Medicaid won’t fix the fact that nearly 45% of Americans report being underinsured, or the fact that hospitals, pharmaceutical corporations and insurance companies are still extorting Americans by inflating health care costs to an outrageous degree. However, until we as a nation can work to find a solution that undoes the greed that has corrupted our health care system, a short-term solution can make a life or death difference for hundreds of thousands of Missourians.

If you want to help in the effort to expand Medicaid in our state as soon as possible, let me know! And make sure to follow Missouri Health Care for All on Facebook, Instagram and Twitter, and sign up for email updates and opportunities to get involved here.


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