[Note: this story has been modified since its original posting to correct errors.]
The number of Missourians who had no health insurance in 2002 rose to almost 650,000, many of whom lacked coverage because they also lacked a job.
But more and more, even Missourians who are working are likely to be without health insurance.
“Our assumptions about who is uninsured are wrong,” said Connie Mihalevich of the Missouri Department of Health and Senior Services. “A lot more are middle-income and young adults.”
Leslie Green is one of several employees of James Fence Co. in Columbia who took a pass on her employer-sponsored health insurance. Green decided two years ago that she’d take her chances without coverage, while others took advantage of their spouses’ health plan.
“They offered us health insurance, but we all decided not to take it,” Green said. “It wasn’t worth it.”
Eleven percent of Missouri residents are uninsured, according to 2002 data from the U.S. Census Bureau, a slight increase over the previous year.
The state’s unemployment rate also rose modestly, from 5.1 percent to 5.5 percent in 2002. But a weak economy and rising premium costs have some employers struggling to provide health care for employees.
To complicate matters, many workers, like Green, can’t cover their portion of the costs.
Brad Jones, state coordinator for the National Federation of Independent Businesses, which has 13,500 members in Missouri, said small businesses “have just been clobbered” by rising premium costs.
“Most of these businesses don’t provide health care because of the cost,” Jones said, “not because they don’t want to.”
According to the U.S. Census Bureau, 60 percent of the 43.5 million people who had no health insurance in 2002 worked for a small business or were dependent on someone who did.
Local small-business owners say that, as costs continue to soar, providing health insurance to their employees requires constant budget manipulation.
Many have been forced to eliminate their employees’ health plans or ask workers to assume more of the cost.
Brad Eiffert of Boone County Lumber Co. said making health insurance available to his 32 employees is a burdensome calculation of costs and benefits every year.
“Unfortunately, the only way we’re able to maintain insurance is to dilute the benefit,” he said. “The benefits continue to mean less and less.”
Debin Benish, president of Delta Systems Group, offers health insurance to her seven employees but not to their dependents. Benish says that while providing basic coverage is a “priority” for her, the cost has increased annually by an average of 30 percent.
“We’ve trimmed (the benefits package) back in a couple of places,” Benish said, “places that aren’t going to hurt people too much.”
One of Benish’s employees, Lisa Winch, learned the value of an employer-sponsored health plan when she made a recent trip to the emergency room. Care that would have cost Winch more than $2,000 without insurance was only $75.
“If I didn’t have it, I would need to get paid more,” Winch said. “More than likely, I wouldn’t purchase it myself.”
As the number of the uninsured increases, social services agencies like the Family Health Center in Columbia, which provides discounted health care to those who couldn’t otherwise afford it, have noticed an increase in demand for services. Executive Director Gloria Crull says many of the clinic’s new patients are from the nearly 500 area small businesses.
“Certainly the demand for services is not decreasing — it is increasing,” she said. “We have more new patients calling to get appointments than we can fit into the schedule.”
The U.S. Department of Health and Human Services recently awarded Missouri $938,489 to gather information on the state’s uninsured population. Mihalevich says the study will examine how other states are insuring residents and how to help state health officials tailor health care models for Missouri.
One factor that contributes to Missouri’s uninsured rate is the number of residents who live in rural areas. Nationally, one in four uninsured people live in rural counties, according to census data.
“Rural residents are more likely to be self-employed or in small businesses and earn low wages,” said Kristofer Hagglund, associate dean of health policy for the MU School of Health Professions.
One proposed solution is to somehow make it easier for small businesses to offer health insurance to employees. Sen. Jim Talent, R-Mo., has been pushing for a bill that would allow small businesses to join trade associations that would be obligated to provide health care coverage to each member. Talent thinks the measure could reduce the number of uninsured by 8.5 million.
Jones, the state’sNational Federation of Independent Business coordinator, supports Talent’s bill.
“It’s the easiest and best way to (provide healthcare) by having one large group with one set of rules,” he said. “Businesses can tailor the program to meet their needs with a couple of different options that they can choose from, depending on the cost. Anything that we can do to help bring down the double digit cost increases, we support.”
The bill, which President Bush supports, was passed by the House, but has met resistance in the Senate.
Last month, the MU Center for Health Policy held “The Future of Health Care in Missouri,” a seminar to discuss ways to broaden access to heath care, including the need to preserve employer-based plans. Although no strong policy objectives emerged from the conference, it provided an opportunity for health care providers to share their perspectives on the problem.
One speaker, Richard Hastings, the president and chief executive officer of Saint Luke’s Health System in Kansas City, pointed out that many people opt not to pay for health insurance, ignoring the potentially huge financial burden should they get sick. In fact, Hastings said, his own son had to be talked out of dropping his family’s health insurance.
“Sure enough,” Hastings said, “my daughter-in-law had appendicitis.”