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Before ACA, Number of Uninsured Remained Stagnant in St. Louis as Economy Recovered

Adrian Clark | Flickr

Despite progress in unemployment rates, the number of St. Louis residents who were uninsured in 2013 was almost the same as it was five years ago, according to an annual report by the St. Louis Regional Health Commission.   

About 151,000 people were uninsured in St. Louis city and county in 2013—about 11.4 percent of the total population, according to the 2014 Access to Care Data Book. Rob Fruend, who directs the Commission, said Missouri’s decision not to expand Medicaid, coupled with a series of financial cuts built into the Affordable Care Act, puts the healthcare safety net in St. Louis on a "razor’s edge."

“The way the system is currently designed, our providers will not be able to provide the same level of care,” Fruend said.

Even though 42,048 people in St. Louis city and county enrolled in insurance on the federal exchange for 2014, thousands of others fell into the "coverage gap," meaning they make too much to qualify for Medicaid in Missouri, but too little to qualify for subsidies to buy health insurance on the federal exchange.  

With money from federal grants, the Commission operates the Gateway to Better Health program which reimburses providers for primary care and provides medications and dental visits for uninsured people through a network of community health clinics. The grants must be extended each year, making the future of the program uncertain.  

“Right now, we’re doing OK,” said Fruend. “The other punch line from our report is all of this is in jeopardy. Federal cuts are looming and our healthcare providers are seeing less and less money come in.”

Because Missouri did not expand Medicaid under the Affordable Care Act, Fruend said, the high number of uninsured patients will continue to put a strain on hospitals and community health clinics.

Credit St. Louis Regional Health Commission

A Demonstrated Need in North County

At Christian Hospital in north St. Louis County, the number of emergency room visits by people without health insurance nearly doubled between 2009 and 2013, according to the commission report. In contrast, St. Alexius Hospital in the city of St. Louis was the only emergency department in the area to see a decline.

Fruend says the increase in the county can be accounted for because poverty rates have increased there, but community health clinics remain concentrated in the city.

“We haven’t been able to shift our resources fast enough,” Fruend said.

Though numbers for 2014 aren’t yet available, Fruend said hospitals and clinics in lower-income areas will continue to bear a greater financial burden to care for people without insurance if Missouri does not expand Medicaid.

The St. Louis County Department of Health does have plans to establish a community health clinic in Pagedale, which will be part of Beyond Housing’s "Vision 24:1" project. The new clinic may ease some of the demand for emergency services in the northern part of the county.  Dr. Jade James, Deputy Director, St. Louis Department of Health said the project became necessary after St. Louis ConnectCare filed for bankruptcy last December.    

Credit St. Louis Regional Health Commission

“We need to either directly provide, or assure residents have access to quality healthcare,” James said. When the idea was proposed, we began to look at the needs in that community, it really mattered to us that it be successful. It needs to be a facility that will be utilized by the community that’s there.

Plans for the clinic remain in development, but James said it will provide primary and specialty care services five days a week, with a focus on geriatric care.