Missouri Policy Journal


The year 2014 marks the beginning of the implementation stage for the largest number of federal health care reform policies under the Patient Protection and Affordable Care Act (PPACA) of 2010, and Missouri policymakers, health care providers, health insurance companies, and government agencies alike find themselves desperately trying to navigate uncertain waters. It is no surprise that perhaps the two most contentious and far-reaching policies for states under the PPACA mantra, implementation of state health insurance exchanges for the medically uninsured and state Medicaid expansion, stand to generate the largest number of unintended consequences for Missouri residents and the state’s economic well-being. For example, with an estimated 704,000 uninsured individuals in the state of Missouri, Medicaid expansion alone would not only provide health insurance to more of these individuals, but, according to Joel Ferber of the Missouri Health Advocacy Alliance, it would also generate approximately $15.7 billion in federal matching funds to Missouri from 2014 to 2021, while only costing the state $806 million in state match. This organization is a statewide non-profit advocacy organization, which, as its mission states, is “dedicated to quality affordable health care for all.” This issue will be explored. Similarly, state health insurance exchanges are expected to provide affordable coverage to currently uninsured individuals with more moderate incomes, thus reducing cost-shifting to the insured in cases of medical emergencies.