Missouri health care plan loses enrollees

Monday, December 13, 2010 | 12:28 p.m. CST

JEFFERSON CITY — Enrollment in Missouri's health care plan for state workers and retirees has fallen almost 5 percent after the state announced it was making budget-cutting changes that would result in higher out-of-pocket costs for participants.

Beginning Jan. 1, the Missouri Consolidated Health Care Plan is switching from a co-pay to a deductible model, charging families more for covering multiple children and eliminating coverage of some health services.

Records provided to The Associated Press show the number of people covered by the health plans has dropped by 4,855 in the past few months after the changes were announced. That puts the total people covered just a little below 100,000. It's not clear how many of those people now will have no health coverage, have joined a family member's plan through the private sector or will be covered under the government-funded Medicaid program for low-income families.

As a result of the dropouts, health plan administrators will be able to avoid seeking a large funding increase from legislators.

Agency records indicate that the health plan is budgeted to get $410.9 million from the state during the current fiscal year, which runs through June 30. A preliminary estimate had forecast that funding needs to grow to $428.9 million next fiscal year. But a revised funding request approved this past week by the health plan board — which takes into account the lower enrollment figures — now projects the agency to need $411.3 million from the state in the upcoming fiscal year.

Administrators for the health plan intend to survey members about the reasons they decided to drop out.

Cost increases may be the obvious answer for some.

"It's disappointing that many state workers responsible for providing care to other Missourians are now unable to afford health coverage for themselves and their families," said Joe Lawrence, spokesman for the American Federation of State, County and Municipal Employees in Missouri. "As the economy turns around, AFSCME hopes the administration and (the health insurance agency) will work on plan changes that provide the affordable plans state employees deserve."

In the past, most Missouri employees and retirees were covered under co-payment plans in which they pay a flat amount — such as $25 for a doctor's visit or $100 for an emergency room visit — and the state health care plan picks up the rest.

But that option is ending and participants had to choose one of several deductible insurance plans for 2011.

Under one option, employees must pay their first $600 of medical bills each year, then are responsible for 10 percent of their additional medical costs until they reach a maximum total out-of-pocket expense of $1,500, after which the state plan would cover the rest. For family coverage, that deductible would be $1,200, and the maximum total out-of-pocket expense would be $3,000.

Under another option, employees willing to pay higher monthly premiums can have a deductible of $300 and a maximum out-of-pocket expense of $1,200. Family coverage for that plan carries a $600 deductible and maximum out-of-pocket expense of $2,400.

The state health plans also will eliminate coverage for stomach reductions and fertility treatments, start charging families more money for covering multiple children and will rely more on generic drugs. 

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Nelson Richter December 13, 2010 | 12:57 p.m.

I taught in a small school that carried health insurance that had a $1500 deductible on individuals $5000 on families; needless to say the salaries of many of the teachers did not allow them to carry the insurance. When I researched the company I found that their profits were huge, their CEO and top officers received bonus awards of well over 1 million dollars. Health care reform in the United States, who needs it? We the people.

(Report Comment)
Jimmy Bearfield December 13, 2010 | 3:41 p.m.

Nelson, research also shows that if all health insurance companies were not allowed to make any profit whatsoever, the savings would not even come close to being enough to cover the cost of universal care.

I guess we could try capping physician pay. For example, primary care physicians in France make, on average, about half of what their U.S. counterparts do ($79,000 vs. $150,000). Would that be enough to ensure that everyone has "affordable" care? I don't know. Maybe somebody could do the math and let us know. Would also be interesting to hear what doctors think, especially when lots of surveys show that many of them will retire rather than accept lower reimbursement -- even from private insurers, which use Medicare/Medicaid to set their rates.

Most likely it's going to be federal income taxes: About half the population will be stuck carrying the weight for the other half.

(Report Comment)
Christine Carrier December 15, 2010 | 4:58 p.m.

When my brother got a deep gash in his hand, he gave himself stitches. I told him I thought that was crazy, but he said his family was already tapped out. He didn't want to start making payments to the hospital and the emergency room.

A friend of mine bought penicillin from a livestock feed store, telling them she needed it for her pigs. Needless to say, she doesn't have any pigs.

Another acquaintance refused medical care after being rear-ended by a hit and run driver, because he feared getting stuck with medical bills he couldn't pay. He still suffers from neck and back pain.

While I don't pretend to understand all the dynamics involved with the medical and insurance professions, it's clear that something's very wrong in the way our country is handling its health care. I'm also convinced that there is a lot of intentional double talk going on, so that we're afraid to actually tackle the problem head-on.

I'm afraid "business as usual" is going to cost a lot of lives.

(Report Comment)

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