The Affordable Care Act’s online health insurance marketplace has been open for business since October 1 and technical issues that plagued the website early on have mostly been resolved. Yet Missouri residents have been slow to sign-up for health insurance under the new law. According to the nonprofit group Kaiser Family Foundation, only 40 percent of Missourians eligible to enroll have actually chosen a plan. I spoke with U.S. Secretary of Agriculture Tom Vilsack about why signing up is important for Missouri residents, particularly in rural areas.
This interview has been condensed and edited for content and clarity.
What message do you have for rural Missourians concerning the ACA?
This is, I think, a critical period of time. March 31 is the deadline for signing up for coverage under the Affordable Care Act. The next sign-up period won’t occur until November, so we're encouraging folks to go on the website at healthcare.gov or use the 1-800 number at 1-800-318-2596. They might be surprised at the range of policies that are available and the cost. We are seeing a significant percentage of folks who are uninsured or who have struggled in terms of healthcare coverage securing policies for $100 or less a month. And I think it’s extremely important for rural folks to look at this because in the past rural folks spent more money out of pocket for healthcare, they had a higher level of uninsured populations, the senior population struggled with prescription drug costs, and all of that resulted in less access to healthcare and poorer outcomes.
So now that they will be getting more affordable care, what about the access? How has that improved?
If you look at the old system where an uninsured person would walk into a clinic or a hospital and would not be able to pay for the healthcare they needed but would still get the healthcare, the cost of that would either have to be eaten by the clinic or the hospital or it had to be shifted to somebody else who had insurance coverage. That raised the cost for folks who had insurance or it put the clinic or hospital at risk. Now, with everyone being able to secure insurance, and more and more people having insurance, there’s greater predictability in income steams for those clinics and hospitals, which makes it a little bit easier for them to obtain and attract quality help, or attract physicians and nurses and other professionals. It may allow them to purchase up-to-date equipment so that they can provide better healthcare.
That shortage of primary care doctors and nurses is a real issue for us here in Missouri. How is the healthcare law designed to tackle this problem?
The ACA I think makes it easier to attract family docs and primary care physicians because now they can be assured they’re not going to be confronted with a substantial percentage of their patients walking into their clinic or their hospital and not be able to pay the bill. The financial stability and security of payment that is a result of having more people with healthcare coverage is a really important part of the ACA that often does not get as much attention as it deserves.
The Missouri state legislature has so far declined to expand Medicaid coverage in the state. How do you see this affecting rural Missourians specifically?
If folks are covered by Medicaid with Medicaid expansion it makes it just a little bit easier for those folks to get access to healthcare and have it paid for. If folks are not covered and don’t have the opportunity to participate in Medicaid, they won’t get the healthcare they need as soon as they need it, which means that when they do get it they're going to be much sicker. It’s going to be much more expensive to take care of them and the cost of that is going to get shifted to the rest of us who have insurance coverage. It’s unfortunate because the deal with states is that the federal government would pay 100 percent of the cost of this expansion for a number of years and then it would be at 90 percent. It’s an opportunity to attract additional resources into the state of Missouri, put more investments in the healthcare system, and have better outcomes for folks. So I would hope over time they’re reluctance would be overcome, as it has in many, many states.
What do you say to those rural Missourians who have never had health insurance and are reluctant to sign up now?
I encourage them to pick up the phone and dial the 1-800 number, and begin asking the questions that they have and getting the answers that they need to get to a better comfort level. And I think they need to reflect on the fact that without that coverage they don’t have the peace of mind that the rest of us have who do have health insurance. And that peace of mind is that I realize that my family, in fact, just yesterday my son contacted me and said that his wife and two children were involved in a car accident. Fortunately nobody was hurt, but somebody could have been hurt. And if they were it would have been a very expensive hospital and doctor’s bill. It would have been a stressful situation for that family, or for any family. And it might be that the cost of that healthcare is so great that the family never digs out from the financial hole that it creates or they have to file bankruptcy and their credit rating is damaged. This peace of mind, this less anxiety and less stress about that one illness, that one accident that could drive your family into financial ruin, I think, is pretty important.
What do rural Missourians need to know about the upcoming enrollment deadline?
March 31 is the deadline, and if you haven’t signed up by then the next opportunity to sign up is in November. I you are unable to sign up or don’t sign up you may at some point in time be subject to a fine or penalty. That will be assessed at the time you fill out your tax return. And the problem with that is it may be unexpected, you may not realize that that may happen to you and so that refund check that you’re counting on is either going to be less or even zero, and that may come as a shock and surprise to you. So I think it’s important for folks to understand that they’ve got a deadline and hopefully they respond. And we're beginning to see more and more people access the website, access the 1-800 number, and we're seeing millions of Americans either finding out that they qualify for Medicaid, having their child qualify for the Children’s Health Insurance Program, or that they can go on an exchange and get pretty affordable healthcare coverage.