Affordable Care Act/Medicaid

Women’s Voices Continues Advocacy for Medicaid Expansion

November 1, 2022

After Missouri voters overwhelmingly voted to expand Medicaid, the Department of Social Services began enrolling those newly eligible. But it did not go well. In June 2022, the waiting time for application approval was 115 days. This (and the voices of advocates) prompted the federal government to get involved to press the State to act to reduce the Medicaid application backlog.

Today, 92% of applications are being processed in 15 days or fewer. The department’s new enrollment strategies have been extremely effective.
One of the most effective changes has been accepting assessments through the Federally Facilitated Marketplace (FFM) as determinations for eligibility. (The State had been doing a redundant separate determination.) Using the FFM determination requires less State staff time and reduces administrative costs.

The current use of FFM assessments as determinations is scheduled to end in December. WV is part of an effort to encourage the Department of Social Services to extend this policy. This will be particularly important as the state enters the open enrollment period beginning November 1. An increase in applications is expected and continued acceptance of FFM determinations at least through January is critical. Ideally the extension should be permanent.

Health Care For All

After drastic cuts were made in Missouri’s Medicaid program in 2005, Women’s Voices began advocating for quality, affordable health care for all. In January, 2007 we learned about the Massachusetts initiative to provide health care for all their residents and in March, 2007 we stated our position, saying in part that:

Every resident of Missouri deserves to have access to adequate, affordable health care. Providing such a network of care would be a wise investment in the state’s future, benefiting all Missourians, including aging adults, working parents, individuals with disabilities, and the mentally ill.  We called for affordable health services for all Missouri’s children, including prevention services.

See the right column for programs on health care for all, the Affordable Care Act and Medicaid Expansion.

Women’s Voices Recommends a YES vote on Amendment 2-Medicaid Expansion

Missouri voters will have the opportunity to pass a constitutional amendment to expand Medicaid on August 4, 2020.

Learn how Medicaid Expansion will benefit Missouri.

Read more on Medicaid Expansion from the Missouri Hospitals Association

Take Action to Deliver Healthcare for Missouri

Read more about the reasons Women’s Voices supports Amendment 2 here.

The Dollars & the Sense of Medicaid Expansion

July 9, 2020

Mikel Whittier, Coalitions Director for Yes on 2: Healthcare for Missouri discussed Amendment 2: Medicaid Expansion, which voters will decided on August 4. Read the program summary here.

Women’s Voices opposes work requirements for Medicaid recipients

May 4, 2020

Ruth Ehresman, co-president of Women’s Voices testified in opposition to a bill which would have added requirements for Medicaid recipients that would result in many losing coverage and adding unneccesary costs to the state. Ruth said, “Women’s Voices believes that work requirements are flawed social policy will be an unnecessary burden on many families and individuals and will result in some individuals needlessly losing coverage for which they are eligible. For this reason, we oppose HJR106.”

Read the full testimony here:Testimony in Opposition to HB106

Update: The bill did not come up to a vote so this issue has been tabled for now.


Obamacare Turns 10. Here’s a Look at What Works and Doesn’t.

New York Times, March 24, 2020

The law did not achieve universal coverage, but it brought about a historic drop in the number of Americans without health insurance…. Over all, the largest coverage gains under the A.C.A. have been among Hispanic, black and Asian patients — many of the groups that had the highest uninsured rates before the law, the Kaiser Family Foundation found…

Still, health care remains unaffordable for many middle-class people, who don’t qualify for Medicaid or federal subsidies to help buy an individual policy… And the law has done little to address soaring prescription drug costs and staggering deductibles.

It’s saved lives: A recent series of persuasive studies has made clear to researchers that Obamacare really did make people healthier….“At this point now there is enough evidence that we can say confidently that giving people health insurance produces health impacts and positive health changes,” said Benjamin Somers, a physician and researcher at the Harvard T.H. Chan School of Public Health.

It’s made insurers richer: “The individual market remains profitable and stable,” concluded a recent analysis by the Kaiser Family Foundation, which tracked the financial performance of the insurers. Companies, which were once spending nearly every cent of each dollar they collected in premiums on medical claims, were now taking in enough money to have 25 cents left over in the most recent period of 2019.

Biggest Flaw: Surveys of health law enrollees show that the deductibles are patients’ biggest struggle, more so than concerns about having enough doctors in-network or even the price of the premiums. In interviews, people with coverage through the law said they’re simultaneously grateful to have the peace of mind that comes with health insurance and frustrated that they still can’t afford to see a doctor….

So there’s another, harder, way to fix the Affordable Care Act deductible problem: rein in America’s high medical prices. If each doctor visit and hospital stay costs less, then insurers would be able to cover more without asking patients to pay a large share.

“The biggest problem,” said Bob Kocher, a former health policy adviser to President Obama, “is that health care costs have grown relentlessly.”

Read full article here.


New Rule Could Mean Medicaid Cuts

February 6, 2020 – Associated Press

Governors of both major political parties are warning that a little-noticed regulation proposed by President Donald Trump’s administration could lead to big cuts in Medicaid, reducing access to health care for low-income Americans.

The arcane fiscal accountability rule proposed by the Centers for Medicare and Medicaid Services, or CMS, would tighten federal oversight and approval over complex financing strategies states have long used to help pay for their share of the $600 billion program. Also targeted are certain payments to hospitals that treat many low-income patients. Public comments closed last week amid a chorus of criticism from hospitals, nursing homes, insurers, doctors, and advocates for the poor.

….Also in the cross-hairs of the proposed rule are Medicaid “supplemental”payments to hospitals that treat a large share of low-income patients. Those could be curtailed.

Read full article here.

Two Studies Show Medicaid Expansion Will Increase MO Revenue

February 1, 2020 –  St. Louis Post-Dispatch

Expanding the state’s Medicaid program would be a net positive for Missouri’s budget, according to two recently released reports. From the article: “This net increase in the general revenue budget would make funds available that could be used for other priorities, including education,” the think tank’s report states….Pregnant women and people with disabilities already on Medicaid would qualify for this new rate, saving the state more than $235 million, according to the report….Also, $35 million in state-sponsored medical services, such as inpatient hospital visits for state prisoners, would fall under Medicaid expansion. Finally, the report estimates Missouri would generate $50 million in new tax revenue from the health care industry. Read the full article here.

Women’s Voices Supports Campaign to Take Effort to Expand Medicaid to the Ballot

On September 4, Healthcare for Missouri launched the official campaign to expand Medicaid through the 2020 ballot. Women’s Voices is supporting this campaign, and we hope you will volunteer to help it succeed.

The constitutional amendment to expand Medicaid will create jobs and protect rural hospitals. It will bring our tax dollars home. Most importantly, Medicaid Expansion will mean that fewer Missourians will have to choose between health care and other necessities like food or shelter.

We encourage you to learn more about Healthcare for Missouri, view the launch video featuring Missourians in the the Coverage Gap, and sign up to support the campaign at

You can also sign-up with Missouri Health for All to collect signatures for the Medicaid Expansion ballot initiative here.

What Happens if Obamacare Is Struck Down?

An analysis in New York Times says that 21 million could lose their insurance and 12 million adults could lose Medicaid coverage. The ACA (Obamacare) also protects 133 million with pre-existing conditions and has 2 million young adults on parents’ plans.  See more here


Judge strikes down Medicaid work rules in Arkansas, Kentucky

March 27, 2019

While the Missouri legislature is considering work requirements for Medicaid eligibility, a federal judge rules “that the federal government failed to justify that adding employment conditions and other changes to Medicaid in Arkansas and Kentucky advanced Medicaid’s basic purpose of providing health coverage.”  Read more here

Missouri is pushing eligible people off Medicaid — including thousands of children — to save money, critics charge

February 10, 2019

Herb Kuhn, president and chief executive of the Missouri Hospital Association, said the state’s efforts to verify Medicaid eligibility could be tied to an increase in the number of people without coverage that hospitals are seeing. “When we see over 50,000 children come off the Medicaid rolls, it raises some questions about whether the state is doing its verifications appropriately,” he said. “Those who are truly entitled to the service should get to keep it.”

Timothy McBride, a health economist at Washington University in St. Louis who heads a Missouri Medicaid advisory board, said the state’s eligibility system has made it too difficult for people to stay enrolled. Since low-income people move or may be homeless, their mailing addresses may be inaccurate. Plus, many don’t read their mail or may not understand what was required to stay enrolled, he added. “I worry some people are still eligible but just did not respond, and the next time they need health care they will show up with their Medicaid card and find out they are not covered,” McBride said.

Read full article here.

Ruling Strikes Down Obamacare Moves Health Debate to Center Stage


WASHINGTON — The decision by a federal judge in Texas to strike down all of the Affordable Care Act has thrust the volatile debate over health care onto center stage in a newly divided capital, imperiling the insurance coverage of millions of Americans while delivering a possible policy opening to Democrats.

After campaigning vigorously on a pledge to protect patients with pre-existing medical conditions — a promise that helped return them to the House majority they had lost in 2010 — Democrats vowed to move swiftly to defend the law and to safeguard its protections.

On the defensive, Republicans campaigning this fall promised that they too backed the health law’s protections for people with pre-existing medical conditions. But the Texas ruling illustrated the fruits — and possible perils — of their long-running campaign, stepped up in the Trump era, to remake the judiciary through the confirmation of dozens of conservative judges, including two appointees to the Supreme Court.

The ruling, if it stands, would not only do away with coverage protections for people with pre-existing health conditions but also strike down the guarantee of coverage for what the law deems “essential health benefits.” These include emergency services, maternity and newborn care, mental health and substance abuse treatment, prescription drugs and pediatric care.

But it is so sweeping that many legal analysts believe it is likely to be overturned. The Supreme Court, in a 5-to-4 decision, has already upheld the Affordable Care Act’s legality. The political reaction to the Texas decision, though, is not likely to diminish anytime soon….

…The Democrats’ first step will be in the courts; aides to Representative Nancy Pelosi, the top House Democrat, said Saturday that House Democrats would move quickly to notify the Trump administration that they intended to intervene in the case. A vote on a resolution to do so is expected in the earliest days of the new Congress.

Democrats also intend to convene hearings to spotlight the sweeping impact of the Texas ruling … If upheld on appeal, the decision could deprive an estimated 17 million Americans of their health insurance — including millions who gained coverage through the law’s expansion of Medicaid. Still others could see premiums skyrocket as price protections for pre-existing conditions lapse.

The immediate practical effect of the ruling was not clear. While the judge declared that the whole law was invalid, as Texas and 19 other states had asserted, he did not issue an injunction to stop federal officials from enforcing it, and the effects of the judgment could be delayed pending appeals….

…The case is “still moving through the courts,” said the message from the federal Centers for Medicare and Medicaid Services. “The marketplaces are still open for business, and we will continue with open enrollment. There will be no impact to enrollees’ current coverage or their coverage in a 2019 plan.” …

In his ruling on Friday, Judge Reed O’Connor of the Federal District Court in Fort Worth struck down the law on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it. The judge found that the “myriad parts” of the law are all interconnected. Without the mandate, he said, the rest of the law comes crashing down.

The ruling is just the latest chapter in the tumultuous history of a law that has transformed life for millions of Americans since the measure was passed without any Republican votes and signed in March 2010 by President Barack Obama.

The decision puts Republicans in Congress into a political box. Most of them tried over and over to repeal the Affordable Care Act. And many of them survived the Democratic wave in midterm elections last month only by vowing to preserve the law’s protections for people with pre-existing conditions — protections that would be swept aside by Judge O’Connor….

…. Friday’s decision could also give a boost to liberal Democrats who won hotly contested races running as advocates of “Medicare for all.” Even before the court decision on Friday, liberals were promising to make health care a central issue in the next presidential election….

… Recent polls have found that slightly more than half of Americans approve of the Affordable Care Act, with many more, across political persuasions, wanting to keep its provisions protecting people with pre-existing health conditions. But polls have also found that many Americans are unhappy with their health care and its costs, particularly drug prices, and both parties in Congress have taken note.

Under the Affordable Care Act, many people of modest means can obtain subsidies covering all of their premiums, so the insurance is essentially free. But for those whose income is too high to qualify for subsidies, the costs remain high — a problem that the Trump administration and congressional Republicans have seized on….

…Other broadly popular provisions of the law are one that allows young people to stay on their parents’ health insurance plan until they turn 26, and another that allows people to get certain types of preventive care, like vaccinations, mammograms and other types of screenings for diseases, at no charge.

Is there renewed hope for Medicaid expansion in Missouri?

July 23, 2019

Health care advocates in Missouri are closely watching successful efforts to put Medicaid expansion on the ballot in other red states. “There is a sense that it might be time again in Missouri,” Amy Blouin, executive director of the Missouri Budget Project, told the Post-Dispatch.“I don’t think it’s going to happen overnight. People are waiting to see what happens in other states.” Bypassing state legislatures and taking the issue directly to a vote by residents is what has been happening. read more

New Executive Orders on Health Care

On October 12, President Trump issued two new executive order aimed at changing the rules for health insurance.

  1. First, the President issued an Executive Order aimed at allowing insurance companies to sell cheap, junk insurance plans that are exempt from important consumer protections. These plans can discriminate against people with pre-existing conditions, and they don’t have to offer comprehensive coverage.Experts fear these plans will lure healthy people away from high quality insurance with the promise of cheap premiums. As a result, more people will be vulnerable to financial devastation if they suddenly become ill or injured. And, anybody who isn’t in perfect health will face quickly-rising premiums for the insurance plans that can’t discriminate against them.In short, the Executive Order would lead to a two-tier health insurance system: One that sells cheap but skinny plans to people who are currently healthy, and one that sells increasingly expensive to the rest of us – anyone who isn’t in perfect health.
  2. Later that night, President Trump announced that he will halt cost-sharing subsidies that help insurance companies lower deductibles and other out-of-pocket costs for low-income Americans.Experts and elected officials from across the political spectrum agree that this will lead insurance companies to raise premiums even further, and may even lead more insurers to leave the Marketplace. The announcement comes less than three weeks from the start of Open Enrollment for 2018 plans.

What Consumers Need to Know

Most people who buy their health insurance through the Health Insurance Marketplace, you should be worried, but not panicked. Here are some things to know:

  • President Trump’s Executive Order on junk insurance plans will need to go through months of rule-making and public comments, so it will not take effect immediately.
  • By law, insurance companies have to continue providing discounts on out-of-pocket costs like deductibles to those who qualify. If you’re getting these discounts, they will continue. The insurance company won’t get paid back, however, which is why we expect companies to compensate by raising premiums for everybody.
  • If you qualify for premium discounts, those discounts are safe and will hold your premiums steady. Because the price you pay is tied to your income, you will be insulated from premium hikes.
  • If you don’t qualify for premium discounts, you will pay the price for these reckless decisions. Already, insurance companies in many states had filed huge rate increases because of concerns that the Trump administration would stop the cost-sharing reduction payments. Please be sure to contact your members of Congress and tell them how you will be personally impacted by premium increases of 20% or more.

Important Factors in Health Care Reform

Provided by Missouri Health Advocacy Alliance

1. Medicaid– Though most rural residents are in non-expansion states, a higher proportion of rural residents are covered by Medicaid (21% vs. 16%).
Any federal health care reform proposal must protect access to care in Rural America, and must provide an option to a state to receive an enhanced reimbursement included in a matching rate or a per capita cap, specifically targeted to create stability among rural providers to maintain access to care for rural communities. Enhancements must be equivalent to the cost of providing care for rural safety net providers, a safeguard that ensures the enhanced reimbursement is provided to the safety net provider to allow for continued access to care. Rural safety net providers include, but not limited to, Critical Access Hospitals, Rural Prospective Payment Hospitals, Rural Health Clinics, Indian Health Service providers, and individual rural providers.
2. Market Reform– Forty-one percent of rural marketplace enrollees have only a single option of insurer, representing 70 percent of counties that have only one option. This lack of competition in the marketplace means higher premiums. Rural residents average per month cost exceeds urban ($569.34 for small town rural vs. $415.85 for metropolitan).
Any federal health care reform proposal must address the fact that insurance providers are withdrawing from rural markets. Despite record profit levels, insurance companies are permitted to cherry pick profitable markets for participation and are currently not obliged to provide service to markets with less advantageous risk pools. Demographic realities of the rural population make the market less profitable, and thus less desirable for an insurance company with no incentive to take on such exposure. In the same way that financial service institutions are required to provide services to underserved neighborhoods, profitable insurance companies should be required to provide services in underserved communities.
3. Stop Bad Debt Cuts to Rural Hospitals – Rural hospitals serve more Medicare patients (46% rural vs. 40.9% urban), thus across the board Medicare cuts do not have across the board impacts. The fact that according to MedPAC “Average Medicare margins are negative, and under current law they are expected to decline in 2016” has led to 7% gains in median profit margins for urban providers while rural providers have experienced a median loss of 6%. Congress must stop bad debt cuts for rural hospitals.

A look to the Past…..

The ACA Is Here To Stay!   

June 25, 2015

Joyce Borgmeyer, chair of the Women's Voices Health Care Committee

Joyce Borgmeyer, chair of the Women’s Voices Health Care Committee

The Supreme Court ruling maintaining subsidies to offset the cost of health insurance “was a huge win,” according to Robert Gatter, St. Louis University School of Law.  At a celebration of the ruling at Central Reform Congregation June 25, Gatter said that the court did the right thing by interpreting the intent of the statute.   The purpose of having “an exchange established by a state” was to support health insurance markets, not destroy them.   And by allowing consumers who earn 100-400% of poverty to purchase insurance on an exchange, regardless of whether it is run by a state or the federal government, supports health insurance markets.

Tom and LaDonna Applebaum

Tom and LaDonna Applebaum

LaDonna Applebaum stood with Women’s Voices member Melanie Shouse in front of the office of Representative Lacy Clay advocating for the creation of the Affordable Care Act.  Melanie, under-insured, was diagnosed with stage 4 breast cancer and died in 2010.  But while battling her disease she worked tirelessly for health care for all.   LaDonna said, “Because of Melanie, I am here today.”

LaDonna and her husband Tom purchased insurance on the exchange and received their health card January, 2014.  In June, Tom had an accident requiring surgery on his hand.   In August, LaDonna was diagnosed with breast cancer.   She has completed her chemo therapy and radiation treatments.  And for those who claim she and Tom are “takers”, she says, “We’re not takers; we’re giver backers!”  They hope to earn enough next year to not require a subsidy.

Steven Engelhardt, Communication Director for Representative Lacy Clay, read a statement from the representative.  Rep. Clay said that he is gratified that the essential funding mechanism which has provided insurance for 16 million Americans is now the “settled law of the land.”   Clay encourages us to use this win as an incentive to work with our state legislators to expand Medicaid and stop allowing 5.4 million dollars to be lost each day by refusing the federal funds.  Clay says it is “time for our legislators” to provide the same insurance they receive to the 200,000 Missourians who fall into the coverage gap.