Health & Wealth Desk

Wednesday mornings during Morning Edition, and Wednesday afternoon during All Things Considered

KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a short weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.

Contact the Health & Wealth desk.

Images of Money via Flickr

The Affordable Care Act included a temporary bump in the Medicaid fees paid to physicians for certain primary care services. The intention behind the two-year, federally-funded increase was to encourage more physicians to participate in Medicaid to accommodate an expanding pool of Medicaid patients anticipated by the law.

But a 2012 Supreme Court decision opened a window for states to reject Medicaid expansion – Missouri is one of 23 states that have chosen not to expanded coverage – and as of Jan. 1, the Medicaid fee bump is expired as well.

I spoke with Dave Dillon and Andrew Wheeler of the Missouri Hospital Association (MHA) about the impact the fee increase expiration will have on Missouri hospitals.

Bram Sable-Smith / KBIA

The Missouri Association of Local Public Health Agencies (MoALPHA) was founded in 1994 to support the  city and county public health agencies in the state. I spoke with the incoming chair of the association, Gary Zaborac, about the public health challenges facing Missouri in 2015.

Intel Free Press / flickr

As the use of telemedicine expands it is also growing the footprints of medical professionals, and when doctors licensed in one state begin consulting in another, it presents a problem for state medical boards. KBIA’s Hope Kirwan spoke with Jonathan Linkous, CEO of the American Telemedicine Association, about how states are regulating telemedicine.

Katie Hiler / KBIA

If you’ve ever lived in - or even visited - a small town, you know they can be pretty quaint. And Milan, Mo, population 1,881, is no exception.

Milan’s local hospital, Sullivan Country Memorial, has been around since 1953. Joe McCarty, a local resident and now patient in Sullivan’s long-term care unit, has lived in Milan almost his entire life – he’s turning 100 this year. Joe made his living as a cartoonist and up until just a few months ago he worked for the local newspaper.

Intel Free Press / Flickr

  Dr. Karen Edison is a dermatologist with the University of Missouri Health system. She has been using telemedicine for over 20 years to see patients at clinics in underserved areas of the state, and to follow-up with her rural patients in their homes. She can see photos of her patient’s skin, answer their questions through email, as well as talk with them through video calling.

Edison says telemedicine is a useful tool because it can save rural patients a trip to her office.

But rural patients aren’t only the ones looking to save time and money.

Missouri Foundation for Health

  Open enrollment for health coverage in 2015 is underway, and some Missourians satisfied with their current health insurance may be surprised to learn that parts of their plans, including premiums, are changed for the coming year. The Cover Missouri Coalition, a program of the Missouri Foundation for Health, is encouraging consumers to review their options during this year’s open enrollment period.

I spoke with Ryan Barker, Missouri Foundation for Health’s Vice President of Health Policy, about changes in this year’s health insurance marketplace.

  Last week marked the beginning of open enrollment for the federal health insurance marketplace, and on the surface it appears not much has changed. By some measures premiums before tax credits are just as affordable as last year - decreasing on average by about one percent according to a report by the Kaiser Family Foundation. But to be a savvy shopper, many consumers should give the marketplace a second look.

Obesity is the number one public health issue in Missouri – it affects more than 30% of adults and nearly one in seven children between the ages of ten and seventeen.


The Healthcare Equality Index is a national benchmarking tool that ranks hospitals based on whether their policies and practices include equal treatment for the LGBT community. Missouri’s standing in this index jumped from 37th  in the nation to 6th in just one year.

I spoke with Andrew Shaughnessy, Public Policy Manager of the Missouri LGBT advocacy organization PROMO, about why this ranking is so important and what it means for Missouri. 


Obesity is the number one public health issue in Missouri – it affects more than 30% of adults and nearly one in seven children between the ages of ten and seventeen. But in order to solve the problem of obesity in Missouri, we need to first understand why it exists. Intersection host Ryan Famuliner will lead the discussion of some of the physical, cultural, and even political events that have brought on what is considered by many to be a public health crisis in our state. 

Join us this Tuesday at 7pm for “Missouri: State of Obesity,” a live taping of KBIA’s talk show Intersection. 

LGBT, pride
nathanmac87 / Flickr

  Last month, the Human Rights Campaign called on the Centers for Medicare and Medicaid Services to address LGBT discrimination in healthcare.

Sarah Warbelow is the Legal Director for the Human Rights Campaign, a national LGBT advocacy organization. She said many LGBT individuals are hesitant to seek care based on a history of discrimination by healthcare providers.

Brad Montgomery / Flickr

It’s a well known fact that fast food contributes to poor overall health. But what about the receipt that comes with those yummy French fries?

I sat down with MU researcher Dr. Fredrick vom Saal, whose recently published work shows how fast food receipts expose us to a dangerous endocrine disrupting chemical called BPA.

Robert S. Donovan / Flickr




When people think of the United States Department of Agriculture, they of course think about things related to agriculture - farms, crops, livestock.

But Secretary of Agriculture Tom Vilsack said the USDA is about much more than that. It’s really about improving the quality of life in rural areas.  

“It's important I think because of the people who live in rural America and the contributions they make to the rest of the country," Vilsack said.

Women's Foundation

In partnership with the Institute of Public Policy at MU, the Women’s Foundation of Kansas City is collecting information about Missouri women for a public database, including things like income and employment, education, childcare and health.  I spoke with Wendy Doyle, President and CEO of the Women’s Foundation, about how the project could have an impact on women's issues in Missouri.

Shardayyy / Flickr

Studies have shown that students who went to preschool have higher rates of achievement later in school. It's also believed that preschool has a positive effect on children’s social and emotional development.

But the Missouri Department of Elementary and Secondary Education has identified several areas of the state where families don’t have access to quality preschools. The state has applied for a grant through the U.S. Department of Education to expand the state’s program in these high-need areas. Missouri is competing with 16 other states for the Preschool Development grant, which will be awarded by the end of December.

KBIA’s Hope Kirwan sat down with Stacey Preis, Assistant Commissioner for the Office of Early and Extended Learning, to talk about Missouri’s need to expand preschool education.

Hope Kirwan / KBIA


Matt Gibbens has been riding all-terrain vehicles, or ATVs, for a long time, but he’s never taken a safety course.

“I know there's a lot of them out there but I've just grown up on them,” Gibbens said.

Gibbens grew up on a farm and said he’s used ATVs for both work and play. But despite his experience with the machine, he’s still dressed from head to toe in protective gear, including a helmet, goggles, and chest protector.

Gibbens said he thinks about safety every time he gets on his ATV.

This is the fifth story in a series from the Health & Wealth desk on Healthy Nevada. 

All this week we’ve been talking about the population health experiment that the health technology company Cerner is conducting in the town of Nevada, Missouri. But there are still a lot of unanswered questions. Will Cerner’s message and grassroots approach resonate with people in this rural community? Can small changes like new playground equipment and a community garden really have an impact on Nevada’s poor health rankings? And, more simply, will this program work?

To help forecast what may come from Cerner’s efforts in Nevada, I spoke with Dr. Keith Mueller, the Director of the Rural Policy Research Institute at the Center for Rural Health Policy Analysis. 

This is the fourth story in a series from the Health & Wealth desk on Healthy Nevada

The TV show “Parks and Recreation” chronicles civic life in the small fictional town of Pawnee, Indiana. Rural Pawnee is depicted with broad brushstrokes for comedic effect – ordinary town hall meetings frequently turn violent over small issues, soft drinks come in outrageously huge sizes, and a dedicated idealistic city hall employee named Leslie Knope will stop at nothing to help her community.

But in Nevada, Missouri, that parody of a rural town isn’t too far from the truth, right on down to that idealistic, dedicated civic leader.

Greg Riegler / Flickr

Around 1950, cities in the U.S began adding fluoride to the water supply as a way to reduce tooth decay. And ever since, water fluoridation has been a debated issue. Despite evidence that fluoride treatment is beneficial to oral health, the town of Waynesville, Mo. recently voted to stop adding fluoride to its water system. 

But ending water fluoridation in Waynesville didn’t involve activists, budget cuts or a heated debate.

This is the third story in a series from the Health & Wealth desk on Healthy Nevada

Dr. Kristi Crymes is a family medicine doctor at the Nevada Medical Clinic. Crymes came up from Springfield three years ago to work in Vernon County, which has some of the state’s poorest health rankings. In 2010 the obesity rate in Vernon County was 30 percent. The incidence of adult diabetes has hung around 11 percent for the past 3 years. 

This is the second story in a series from the Health & Wealth desk on Healthy Nevada

The town of Nevada, in southwest Missouri, is changing in very subtle ways. To see it you really need to know where to look. For example, Walton Park, on Atlantic Street, used to be one of the town’s less popular parks for kids – just a small slide, a merry-go-round, and two swings. But today Walton Park is where all the cool six-year-olds go, thanks to one new piece of playground equipment.  

This is the first story in a series from the Health & Wealth desk on Healthy Nevada

Pookie Decocq is the healthy living coordinator for the YMCA in Nevada, Missouri. She’s also the town’s official Pickleball Ambassador, which is a team sport played with two wooden paddles, a whiffleball and a low net, like ping pong or badminton.

Pookie’s dream is to hold a pickleball tournament here in this rural town in southwest Missouri. But the average Nevada resident isn’t exactly the picture of health. Like a lot of small rural towns in the state, Nevada has very high rates of obesity and heart disease. Its diabetes rates are some of the highest in the country at 11 percent.

Hope Kirwan / KBIA

  Mizzou student Alex Talleur volunteers at the Community Garden at Kilgore’s Medical Pharmacy in Columbia.

As Talleur pulled green, prickly cucumbers from the yellowing vines, he said he’s envious of the kids who will be munching on the fresh produce in a few days.

"When I think of schools or anything like that, I always think of the greasy cafeteria food," Talleur said. "Having an opportunity to have really healthy, homegrown food is really great."

COD Newsroom / Flickr


Primary health care is no longer limited to the family doctor. With the growing popularity of clinics like the new Mizzou Quick Care, nurse practitioners are becoming more involved in providing primary care.

Jonny Williams / Flickr

Of the numerous items Missouri legislators will consider during this veto session, Senate Bill 841 has state health advocates paying attention. The bill's main purpose was to ban the sale of e-cigarettes to minors. But these good intentions may have led lawmakers astray.

Austin Federa / KBIA

In the wake of the Michael Brown shooting, residents of Ferguson are still dealing with the emotional effects of the conflict.

Bianca Huff and her three-year-old son live in Canfield Green, the apartment complex where Michael Brown was shot and killed on August 9. Five days after Brown’s death, KBIA producer Bram Sable-Smith talked with Huff about how she has been helping her son understand everything that has happened.

“He’s seen the police before, so he was like ‘Did the police do this?’ and ‘How did the boy pass?’ and just different questions,” Huff said. “And he be like ‘So he gone?’ And I said ‘Yeah, he gone but he in a better place’ And he just say ‘Ok’ and keep going about the day. So as long as he don’t get too distraught, I just let him do that.”

Fortunately, there are people already on the ground in Ferguson helping people like Huff and her family cope with the recent tragedy in their community.

Billion dollar day care

Aug 27, 2014
Nori / Flickr


Zsanay Duran lives at the end of a cul-de-sac in her neighborhood in Springfield, Mo. Inside her house looks less like a home and more like a daycare center.

Duran began providing unlicensed home daycare sort of by accident. Last fall when she was looking for work for her teenage son, she came across a posting on Craigslist from a mother who was desperate for childcare. The woman had an 8 month old baby and worked the 5am shift at a local fast-food chain. She could only afford $12 a day for childcare. Duran said her story really hit home.

“I was a single mom and I needed help in order to get on my feet and that’s why someone did for me,” Duran said. “And if I can help someone else get on their feet, why not?”

Kyle Spradley / MU News Bureau

Over 1 million Missourians experience some level of food insecurity and the Food Bank of Central and Northeast Missouri is looking to do something about it. Through MU's Grow Well Missouri Project, people enrolled in Missouri's Food Bank program can receive fruit and vegetable seeds and transplants along with their monthly package of food.

Hope Kirwan / KBIA


  As Father Knute Jacobson of Calvary Episcopal Church in Columbia prays, farmers and their families bow their heads and press their hands to a big, green, John Deere combine.

The combine blessing was just one of the events at the Boone County Farm Bureau’s Safety Expo held in Columbia Saturday, August 2. It was the first time attendees had been invited to pray for the collective safety of farmers this upcoming harvest season.

woodleywonderworks / Flickr

Missouri is headed to the polls this week to vote for, among other things, a ¾ cent sales tax increase that would be used to fund Missouri’s Department of Transportation, or MoDot. Missouri citizens have the special privilege of deciding whether to bankroll a decade of transportation projects, thanks to former Missouri congressman Mel Hancock.

Hancock grew up in Springfield, Mo and before being elected to the U.S House of Representatives in 1989, he forever changed Missouri’s tax code with something called “The Hancock Amendment.” The amendment limits the power of the state legislature to raise taxes on its own, only allowing for small, inconsequential bumps. Voters have to approve bigger tax increases in an election, like the one Missouri is having this week.