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What you need to know about Missouri’s changing ACA health insurance premiums

Sidney Watson, a SLU law professor and local expert on the Affordable Care Act, answered questions about health insurance premium increases in Missouri on Friday.
Kelly Moffitt | St. Louis Public Radio
Sidney Watson, a SLU law professor and local expert on the Affordable Care Act, answered questions about health insurance premium increases in Missouri on Friday.

By now, you’ve likely heard the headlines, news bites and chatter around the dinner table: the prices for many individual Affordable Care Act health plans are going way up across the country. Here’s a good summary of what is happening nationwide.

In Missouri, some people with individual insurance plans could see their rates increase by 40 percent. The Saint Louis University School of Law broke down what rate increases would look like in different cities across the state and, by comparison, St. Louis fares pretty well. The monthly premium for a “silver plan” for a 40-year-old non-smoker earning $30,000 per year, the standard health insurance plan, would only increase by 8 percent.

That’s still a hike, but less disturbing than somewhere like Warrensburg, where that rate would increase by 44 percent. St. Louis also fares better in term of the numbers of plans available to area residents: there are 23 plans available in the area compared to places like Warrensburg, which only have two plans available.

On Friday’s “Behind the Headlines,” we heard from Sidney Watson, J.D., a Saint Louis University health law professor, who helped parse through the health insurance premium hikes and discuss who would be impacted. Below, we’ve summarize some of her more important points.

First and foremost: Most people are protected from the large premium hike because they qualify for premium tax credits.

For 87 percent of people who purchase marketplace individual plans, there will be no visible increase because federal tax credits will reduce your costs. In fact, across Missouri, most people who receive federal tax credits will see their monthly premium go down by 0.5 percent.

In most areas, however, people will have to change insurers in order to procure the lowest cost plan.

That might also include changing your healthcare providers.

Premium rates are going up for three main reasons.

Watson said that premium rates are increasing because:

  1. Insurance companies were overly optimistic when they set low premiums at the start of the healthcare marketplace.
  2. There is a lack of healthier, younger people signing up.
  3. Risk adjustment payments from the federal government have gone up.

Not aiding the situation are health insurers who have pulled out of the health insurance marketplaces. Both United Healthcare and Aetna have pulled out of the marketplace in Missouri. Most Missourians only have a choice of one carrier now.
Expanding Medicaid would help decrease premium costs in Missouri

“States that have expanded Medicaid have premiums that are seven percent lower than states without expanded Medicaid,” Watson said. “It’s because as a matter of population health that the lower your income, the less healthy you tend to be — whether it is about stress or ability to buy healthier food. In states like Missouri where we didn’t expand Medicaid, we have more lower income people signing up for the marketplace and they would be eligible for expanded Medicaid.”

What would happen if the Affordable Care Act would be repealed?

“Right now, nine out of 10 Americans have health insurance,” Watson said. “It is the first time we’ve had an uninsurance rate that’s below 10 percent since 1959. Millions of people would lose health insurance because health insurers could turn people down for pre-existing conditions, charge higher rates for pre-existing conditions. It would be a tremendous loss.”

Over 10 million Americans have marketplace health insurance coverage. In Missouri, we have 290,000 people covered through marketplace plans.

If you choose not to be insured, your tax penalty will rise.

Next year, the lowest penalty you would pay for electing not to buy health insurance would be around $700, Watson said. It goes up from there depending on your income. Last year, 5.6 million Americans paid the penalty when the average penalty price was $442.

Open enrollment starts Nov. 1 and runs through Jan. 31, 2017

Your only opportunity to enroll in individual Affordable Care Act health insurance plans is during this time period. Even if you enrolled last year, Watson recommends that people shop around for plans that might be cheaper.

Need help enrolling? Watson recommends checking out covermissouri.org, where you can set up a meeting for advice.

St. Louis on the Air brings you the stories of St. Louis and the people who live, work and create in our region. St. Louis on the Air host Don Marsh and producers Mary Edwards, Alex Heuer and Kelly Moffitt give you the information you need to make informed decisions and stay in touch with our diverse and vibrant St. Louis region. 

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Kelly Moffitt joined St. Louis Public Radio in 2015 as an online producer for St. Louis Public Radio's talk shows St. Louis on the Air.