Missouri wisely moves ahead on health exchanges
A health insurance exchange is a great idea for Missourians who must buy individual policies because the exchange assures that insurers are offering the same levels of coverage for the premiums charged, encourages price competition among insurers, and simplifies the process of comparing one policy with another.
Nonetheless, Missouri Republican State Sen. Rob Schaaf of St. Joseph last week opposed a state-sponsored health insurance exchange citing data purporting premiums for an “average family” in Missouri were lower than those in Massachusetts. But Schaaf forgot insurance premiums tell only a fraction of the story about the availability and quality of health insurance associated with those premiums.
I got the scoop on health insurance policies by using an exchange to shop for health insurance. You can, too. The Massachusetts health insurance exchange, Massachusetts Connector, is online at mahealthconnector.org/portal/site/connector/. It makes shopping for individual health policies easy and transparent. I typed in a family size of 3, entered a 1976 birth year, a Massachusetts zip code (I used 02138 for Cambridge) and the Connector showed me my options.
First, the Connector asked me if I earned less than $55,596 per year. If so, my family of three is eligible for a subsidy that caps premiums at a percentage of income.
All the policies listed on the Massachusetts Connector cover prescription drugs, maternity care, and mental health treatment. The premium quoted is a guaranteed rate: I could not be charged more if I was sick, a cancer survivor or had a chronic illness. I was guaranteed coverage and could not be turned down (as long as I really did live in that Cambridge zip code). There are three levels of coverage — bronze, silver and gold — with various premiums and deductibles, from none to $250 individual/$500 family, up to a maximum of $2,000 individual/$4,000 family.
It’s not so easy to shop for health insurance in Missouri because we do not have a state insurance exchange. But Healthcare.gov, a new website maintained by Health and Human Services, allows individuals and families to see some of the policies offered in Missouri. Not all insurers list their products but it gives some idea of the policies available here.
Yes, health policies listed for Missouri quote lower premiums than the Massachusetts Connector, but there are also no guarantees. Companies report turning down 5 to 30 percent of applicants and charging higher premiums than those posted online for another 21 to 31 percent.
Policies marketed in Missouri also have high deductibles and sketchy coverage. No policies listed cover maternity benefits. One in five plans does not cover prescription drugs. Almost a third have deductibles of $10,000 or higher, half have deductibles ranging from $5,000 to $10,000, and the lowest deductible advertized is $1,500. The premiums look good at first blush, but if you get sick and need medical care, it’s going to end up costing a lot more in Missouri than Massachusetts because of those high deductibles and limited benefits. Missouri buyers beware.
In 2014, the Affordable Care Act will change how health insurers do business in Missouri. Insurers will no longer be able to refuse to sell policies to people who have pre-existing conditions. All policies offered in the individual market will have to cover maternity care and prescription drugs. New limits will apply on annual out of pocket costs and deductibles.
Insurance exchanges will help consumers shop for health insurance policies and make available refundable tax credits for families of 3 with incomes up to $73,120 that will limit health insurance premiums to a sliding scale of 2 percent to 9.5 percent of income. Too bad Shaaf made up his mind before he heard these facts.
Sidney D. Watson, of St. Louis, is a professor of law at Saint Louis University Center for Health Law Studies.