affordable care act

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In his proposed budget, President Barack Obama wants to delay cuts to federal payments to hospitals, keeping the payments intact for an extra year. That could affect the debate over expanding Medicaid in Missouri.

Through what’s called the disproportionate share hospital payments or DSH payments, the federal government gives money to hospitals that provide a lot of free care to patients who are uninsured and can’t afford services. The Affordable Care Act, though, includes significant cuts to DSH payments.

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The uphill congressional battle to expand Medicaid in Missouri is making rural hospitals that serve areas with high poverty levels really, really nervous. KSMU's Jennifer Davidson has the story.

Nixon open to GOP-backed Medicaid plan, but with changes

Apr 3, 2013
File photo / KBIA

Governor Jay Nixon says he could support the House Republicans’ alternate Medicaid proposal, but only if some crucial changes are made.  He met with the GOP caucus today to discuss his Medicaid expansion proposal and their plans to reform the system.  Nixon told reporters that any proposal still needs to expand Medicaid to 138 percent of the federal poverty level.

Missouri Capitol
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Missouri’s Republican-led House on Tuesday struck down Democrats’ attempts to include Medicaid expansion in the state’s budget.

If that scenario sounds familiar to you, it’s because these rejections have happened a few times before. On Feb. 25, two House committees rejected Rep. Jake Hummel’s (D-St. Louis) bill to expand Medicaid under the terms of the Affordable Care Act. On March 14, the Senate Appropriations committee voted down the Senate Democrats’ version of the expansion bill.

Rep. Jay Barnes (R-Jefferson City) was in one of the committees that struck down Rep. Hummel's Medicaid expansion proposal. Barnes has since introduced his own version of the expansion -- outlined in House Bill 700

Libby Burns / KBIA

This is the second in a two-part discussion about health literacy and the healthcare reform.  

Not knowing what the online health insurance marketplace looks like might be problematic for Missourians. 

As part of the Affordable Care Act, Missouri’s uninsured can choose to buy insurance from the state’s health exchange come October. The exchange is an online marketplace where anyone who isn’t already insured will be able to compare and purchase private insurance plans. Some uninsured Missourians would be eligible for help with the cost, too.  

Missouri has missed the deadline to create its own marketplace or start a state-federal partnership. So, the federal government is setting it up. The problem is, even though the marketplace is supposed to be open for enrollment in about six months, no one knows what it looks like yet.

“We’re losing time that could be useful in helping people understand and prepare [for the exchange],” said Catina O’Leary, the director of Health Literacy Missouri, a nonprofit group that’s working to make health care topics more understandable for Missourians. “It would be really great if we could manage people’s expectations and start training on what they’re going to need to know.”

But here's what we know so far: 

Harum Helmy / KBIA News

On this week's Health and Wealth Update, the first part of a discussion about health literacy and the healthcare reform. 

Harum Helmy / KBIA News

The St. Louis-based nonprofit, nonpartisan group Missouri Foundation for Health held a community forum in Columbia at the ARC Monday night about the state’s Medicaid expansion debate. The foundation’s director for health policy Ryan Barker presented the pros and cons of the expansion to an audience of about 45 people, before opening up the floor to questions.

Amy Mayer / Harvest Public Media

This week, we'll examine the Affordable Care Act's impact on farmers, and hear how one enzyme manufacturer was able to grow its business.

Amy Mayer / Harvest Public Media

Marilyn Andersen raises angora goats and llamas for wool that she spins and weaves in her studio at Two Cedars Weaving in Story City, Iowa. She also has a part-time job coordinating distribution of local produce through a service called Farm to Folk. Neither effort comes with health insurance.

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Barring a congressional miracle,  Medicare payments to health care providers throughout the country will see a 2 percent reduction come Friday. That amount might not sound like much, but rural hospitals and their surrounding communities are the ones that would feel most of the pinch.

Marshall Griffin / St Louis Public Radio

Medicaid expansion is dead for now in the Missouri House.  Two separate House committees voted down efforts Monday to expand Medicaid to 259,000 Missourians next year and 41,000 more in later years.

Watch the show and join the conversation on the Intersection website.

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Efforts to establish a prescription drug monitoring program in Missouri are making a comeback this year. But there’s a twist: the main opponent of establishing such a program is now sponsoring legislation.

“I think it’s a severe intrusion of our liberty to have the government create a database that is accessible by thousands of people, if not tens of thousands of people, who would then have access to sensitive private information,” said Republican Senator Rob Schaaf, a physician in St. Joseph, Mo.

More on the money in medicaid expansion debate

Feb 5, 2013
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Healthcare reform was on the agenda in Gov. Jay Nixon’s 2013 state of the state address as he called upon lawmakers to broaden Medicaid so more Missourians would have access to healthcare. Nixon’s proposed budget includes an expansion of Missouri’s Medicaid program. Estimates are the plan would add nearly 260,000 lower-income adults to the healthcare program through the use of $908 million in federal funds, money that would be received by opting in to the federal Medicaid expansion. In his recent state of the state address, Nixon argued the expansion would create jobs for many Missourians and would bring increased revenue to the state.

Missouri Secretary of State

 A new report by an MU policy analyst warns about the consequences of a ballot measure passed by Missouri voters last November.

A federal court is scheduled today, to take up one Missouri businessesman’s challenge to a recently enacted provision of the federal health law. The provision requires that most employee-health plans include no-cost coverage of contraceptives. But the rule has faced backlash from several businesses and lawmakers around the region. 

Watch the show and join the conversation on the Intersection website.

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Missourians are already seeing changes in healthcare coverage since the Affordable Care Act was first implemented. According to Ryan Barker,  Director of Health Policy for the Missouri Foundation for Health, changes already affecting Missourians include provisions allowing young people to stay on their parents’ insurance plans until the age of 26, Medicare coverage of preventative services without a co-pay, and a new rule that requires some insurance providers to partially reimburse customers if they don’t limit overhead and administrative costs.

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Missouri’s participation in a federal Medicaid expansion would be an economic boon for the state and even pay for itself, according to a new report commissioned by the Missouri Hospital Association and the Missouri Foundation for Health. Under the federal health law, states can choose whether or not to expand Medicaid, which provides health insurance to the poor and disabled. The federal government would fully pay for an expansion during the first few years, but many state lawmakers, like Republican house speaker Tim Jones, worry about the long-term costs.

Claire McCaskilll
Kristofor Husted / KBIA

U.S. Senator Claire McCaskill says there will be a political price to pay for state legislators who allow the federal government to run the state’s health insurance exchange.

In a conference call with reporters Wednesday, the Democratic Senator said the federal health care law is going to be implemented and the state of the Missouri has the opportunity to get resources from the federal government.

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A new report says Missouri's Medicaid costs could rise by 6.6 percent over 10 years if the state fully implements the federal health care law.

But the report also says almost half of that increase will occur even if Missouri does not expand Medicaid eligibility for adults.

The report by the Kaiser Family Foundation and Urban Institute says Missouri can expect to spend an additional $1.2 billion from 2013 to 2022 as more people join the Medicaid rolls because of the federal health care law.

Doctor
File Photo / KBIA

The federal government will set up and manage a health exchange in Missouri. An exchange is an online marketplace where individuals and small businesses will soon shop for health plans. The Affordable Care Act, or obamacare, requires that all states have exchanges up and running by 2014. States have until next week to indicate whether they will run one or not.

Missouri Lt. Governor Peter Kinder has lost another round in his battle against President Obama’s federal health care law.

The 8th U.S. Circuit Court of Appeals ruled Thursday that the Republican Lt. Governor has no legal standing to file suit because the Affordable Care Act poses no immediate threat to Kinder’s legally protected interests.  He filed suit two years ago as an individual, not in his official capacity as Lt. Governor.  The three-judge panel’s ruling did not address the constitutionality of the federal health care law, most of which was upheld last year in a 5-4 ruling by the U-S Supreme Court.

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College of the Ozarks filed a lawsuit today against the US Departments of Health and Human Services, Labor, and the Treasury, arguing that the so-called “contraceptive mandate” in the Affordable Care Act is unconstitutional. 

Richard Freese
Veronique LaCapra / St. Louis Public Radio

When the US Supreme Court upheld the federal health care law in June, it ruled that states couldn’t be penalized for failing to expand their Medicaid programs.

Nixon vetoes controversial contraception bill

Jul 12, 2012
Jacob Fenston / KBIA

Governor Jay Nixon has vetoed a bill that would have exempted religious organizations from covering contraception under their health insurance plans, if that coverage would go against the organizations' beliefs. Nixon said in his remarks that existing law adequately protects religious liberties.

Congress votes to repeal 'Obamacare,' again

Jul 11, 2012

The Republican-led U.S. House of Representatives voted today to repeal the federal health care law. The House has voted more than 30 times to repeal or defund the Affordable Care Act. Every Republican in Congress voted for the repeal, including mid-Missouri's two representatives.

covermissouri.org

In Missouri, an estimated 835,000 people don't have health insurance – that's about 14 percent of the state's population. But in the next couple of years, that figure is going to change. Now that the U.S. Supreme Court has upheld most of the federal health care law, about half a million Missourians will join the rolls of the insured – either through Medicaid, the private insurance market, or with the help of subsidies provided by the federal government. The percentage of uninsured will drop to five percent of the population.

A new report by the Missouri Foundation for Health estimates that about two-thirds of Missouri's more than 800,000 uninsured could get health insurance under the federal health care law  - and the county-level data suggest that rural counties will benefit the most.

The analysis uses census data to project how the number of uninsured could change in every county in Missouri under the Affordable Care Act.

missouri capitol
Jacob Fenston / KBIA

Some of Missouri's largest insurance companies will be refunding consumers almost $61 million this month under a provision of the federal healthcare law. Insurers who failed to spend at least 80 percent of premium-dollars on medical care and quality improvement have to repay the difference to consumers.

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