How health care reform is making a difference for Missourians

By Gary and Marilyn Ratkin

While it has been two and a half years since the Patient Protection and Affordable Care Act of 2010 (PPACA) was signed into law and later sustained by the Supreme Court, many questions remain about what has been accomplished to date.  However, more than 7 in 10 Americans think the law is here to stay (St. Louis Post-Dispatch, Sept. 27, 2012).

U.S. health care may be at the leading edge of applied science and technology for individuals, yet there are many inequities in our system that places this country behind other less-wealthy nations. Americans have a moral imperative to demand reform, which must both improve outcomes for all, regardless of who pays, and reduce cost.  We write to point out the impact of the healthcare reform bill on Missouri citizens to date as examples of the significant reform that has been accomplished.

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The U.S. Department of Health and Human Services has provided a comprehensive online guide (available at to the implementation of PPACA in Missouri, which illustrates the myriad ways the health care law is making a difference in the state. We found the information so important that we updated and consensed the content from the website to bring these accomplishments to readers’ attention.

So, how is health reform is making a difference for you?

Providing new coverage options for young adults: Parents may keep their children under 26 without job-based coverage on their family coverage and as of December 2011, 55,000 young adults in Missouri were positively affected by this law.

Making prescription drugs affordable for seniors: 83,274 Missourians covered by Medicare in 2011 received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole. (The “Medicare donut hole” is a term used for a gap in coverage when a patient’s drug bills exceed a certain amount but aren’t high enough for coverage to kick back in.) Since the law was enacted, Missouri residents with Medicare have saved $78.5 million on their prescription drugs and in the first five months of 2012, 13,876 Missourians with Medicare received a 50 percent discount on brand-name prescription drugs when they hit the donut hole.

Covering preventive services with no deductible or co-pay: In 2011, 729,809 people with Medicare in Missouri received free preventive services – such as mammograms and colonoscopies – or a free annual wellness visit with their doctor. In the first six months of 2012, 348,824 people with Medicare received free preventive services. Because of the law, 1.1 million people in Missouri with private health insurance gained preventive service coverage with no cost-sharing. These services for women were expanded as of August of this year.  

Providing better value for your premium dollar through the 80/20 Rule: Under the new health care law, insurance companies must provide consumers greater value by spending at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. Required rebate checks this year will average $173 for 351,000 families in Missouri.

Scrutinizing unreasonable premium increases: Insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Missouri has received $1 million in 2012, under the new law, to help fight unreasonable premium increases.

Removing lifetime limits on health benefits: Insurance companies can no longer set lifetime dollar limits on health benefits. This portion of the law means that cancer patients and individuals suffering from other chronic diseases will not have to worry about forgoing treatment because of previous lifetime limits.

Creating new coverage options for individuals with pre-existing conditions: As of April 2012, 1,367 previously uninsured Missourians who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under PPACA.

Missouri’s Affordable Insurance Exchanges: Missouri has received $21.8 million in grants for research, planning, information technology development and implementation of Affordable Insurance Exchanges. A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

Preventing illness and promoting health: Since 2010, Missouri has received $11.6 million in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This fund supports  effective policies in Missouri, its communities, and nationwide so that all Americans can lead longer, more productive lives.

Increasing support for community health centers: The Affordable Care Act increases the funding available to the 186 existing community health centers in Missouri which have received $61.2 million to date. These funds are intended to create new health center sites in medically underserved areas, enable health centers to increase the number of patients served, expand preventive and primary health care services, and/or support major construction and renovation projects.

Strengthening partnerships with Missouri: The PPACA gives states support to build the health care workforce, crack down on fraud, and support public health including $10.3 million  in grants to Missouri to support a variety of significant health initiatives (view the full list online at

Improving communication and coordination of health care: Three Missouri accountable care organizations (ACOs), have been accepted in the Medicare Shared Savings Program to improve communication and coordination between healthcare providers of varying disciplines and specialties. The University of Missouri Health Care system was awarded $13.3 million to develop the Missouri Health Connection,  a statewide health network which will allow Missouri hospitals to exchange medical record information in real time.

The Affordable Care Act has begun a long overdue health care reform process.  The goals of eliminating disparities in access to care, discriminatory practices and upgrading substandard outcomes are moral imperatives that must be addressed by our country.  Steps to reduce cost must also continue and should remain a mainstay of the reform effort.