Being Low-Income and Uninsured in Missouri: Coverage Challenges during Year One of ACA Implementation

Katherine Young and Rachel Garfield
Published: May 21, 2015

Table A1: Demographics of Adults in Missouri, by Insurance Coverage
	Uninsured ≤138% FPL	MO HealthNet (Medicaid)	Private Insurance ≤138% FPL	Uninsured ≥138% FPL	Other Insured ≥138% FPL
*Work Status*
Full Time Working Family	33%	17%*	69%*	67%*	82%*
Part Time Working Family	24%	—	14%	—	5%*
Unemployed Family	43%	80%*	17%*	19%*	13%*
*Race/Ethnicity*
Hispanic	6%	—	6%	—	3%*
White, Non-Hispanic	68%	67%	73%	70%	85%*
Black, Non-Hispanic	18%	19%	20%	20%	7%*
Other	9%	9%	—	—	5%
*Gender*
Female	48%	68%*	61%	37%	50%
Male	52%	32%*	39%	63%	50%
*Citizenship*
Citizen	97%	100%*	97%	99%	98%
*Age*
19-25	35%	—	33%	21%	10%*
26-34	27%	13%*	20%	19%	15%*
35-44	16%	14%	16%	25%	23%
45-64	22%	60%*	31%	35%	52%*
*Family Status*
Married with dependent children	15%	10%	18%	19%	34%*
Married, no dependent children	7%	—	14%	21%*	31%*
Not married with dependent children	23%	16%	23%	—	8%*
Not married, no dependent children	55%	66%	45%	42%	27%*
*Insurance Status of Participants’ Children*
Doesn’t have Children	62%	73%	59%	63%	58%
All Children are insured	23%	25%	36%*	19%	40%*
Some or all children are uninsured	14%	—	—	18%	—
*Health Status*
Excellent/Good Health	59%	37%*	80%*	90%*	84%*
Fair/Poor Health	41%	63%*	20%*	—	15%*
Excellent/Good Mental Health	76%	61%*	85%	92%*	92%*
Fair/Poor Mental Health	24%	38%*	15%	—	8%*
Has Ongoing Condition	37%	65%*	33%	19%*	37%
Taking Rx	30%	76%*	44%*	—	49%*
*Rural/Urban*
Rural	29%	39%	29%	37%	23%
Urban or Suburban	65%	58%	67%	55%	74%*
*Length of Time Uninsured*
Uninsured less than 1 year	27%	NA	NA	25%	NA
Uninsured 1-5 years	30%	NA	NA	36%	NA
Uninsured 5+ years	29%	NA	NA	21%	NA
Never had coverage	11%	NA	NA	—	NA
NOTES: Don’t Know and Refused responses are not shown. The “Other Insured ≥ 138% FPL” category is predominantly privately insured people with incomes greater than 138% of poverty, but also includes Medicare enrollees, those who don’t know if they are insured, those who are insured, but refused to answer with what, those waiting for coverage, and other categories of insurance. NA: Not applicable. “–“: Estimates with relative standard errors greater than 30% or with cell sizes less than 100 are not provided. * Estimate statistically significantly different from uninsured estimate at the 95% confidence level. SOURCE: 2014 Kaiser Survey of Low-Income Americans and the ACA.

Table A2: Access to Care and Health Literacy Among Adults in Missouri, by Insurance Coverage
	Uninsured ≤ 138% FPL	MO HealthNet (Medicaid)	Private Insurance ≤ 138% FPL	Uninsured ≥138% FPL	Other Insured≥ 138% FPL
*Usual source of care*
Has a USC that is not ED	45%	79%*	78%*	40%	84%*
Of those with a USC, it is a clinic	38%	30%	24%	—	16%*
Of those with a USC, it is a doctor’s office	40%	51%	59%*	—	72%*
Of those with a USC, it is some other place	22%	18%	17%	—	12%*
Of those with USC, has regular doctor at USC	66%	86%*	79%	—	89%*
Of those with USC, changed USC	20%	—	—	—	8%*
Of those with USC, changed USC & did so because of insurance	—	—	—	—	—
Of those with USC, somewhat to very easy to travel to USC	76%	69%	91%*	—	95%*
Of those with USC, reason chose USC
Convenient	—	24%	29%	—	22%
Affordable	21%	—	—	—	5%*
Only place available	15%	7%	—	—	3%*
Preferred doc is there	37%	52%	52%	—	59%*
Good reputation	—	10%	—	—	9%
*Problems getting appointments*
Told could not get appt with a provider	12%	11%	—	—	4%*
Told could not get appt b/c did not take their coverage	—	—	—	—	—
Had to wait longer than reasonable for any appt.	19%	18%	8%*	—	12%
Had to wait longer than reasonable for primary care	—	—	—	0%	5%
Had to wait longer than reasonable for specialty care	—	5%	—	—	4%
*Utilization*
Used any medical services	55%	91%*	73%*	45%	81%*
Had Checkup or Preventive Care Visit	24%	70%*	52%*	15%	69%*
*Postponed needed care*
Postponed or went without care	55%	46%	25%*	39%*	24%*
Never ended up getting needed care	41%	21%*	11%*	24%*	9%*
*Postponed care & as a result…*
Condition worsened	28%	16%*	10%*	—	7%*
Significant loss of time at work, school or other important life activity	26%	15%*	9%*	—	4%*
Stress level seriously increased	42%	27%*	12%*	20%*	11%*
*Health literacy*
Always/most of the time got all the info wanted from doc	64%	87%*	89%*	—	95%*
Always/most of the time felt encouraged to ask questions	63%	84%*	83%*	—	89%*
Always/most of the time understood test results	65%	82%*	82%*	—	91%*
Always/most of the time understood how to take Rx	80%	89%	93%*	—	94%*
NOTES: Don’t Know and Refused responses are not shown. The “Other Insured ≥ 138% FPL” category is predominantly privately insured people with incomes greater than 138% of poverty, but also includes Medicare enrollees, those who don’t know if they are insured, those who are insured, but refused to answer with what, those waiting for coverage, and other categories of insurance. NA: Not applicable. “–“: Estimates with relative standard errors greater than 30% or with cell sizes less than 100 are not provided. * Estimate statistically significantly different from uninsured estimate at the 95% confidence level. SOURCE: 2014 Kaiser Survey of Low-Income Americans and the ACA.

Table A3: Financial Security Among Adults in Missouri, by Insurance Coverage
	Uninsured ≤138% FPL	MO HealthNet (Medicaid)	Private Insurance ≤138% FPL	Uninsured ≥138% FPL	Other Insured ≥138% FPL
*Confidence can afford usual medical costs*
Confident	22%	65%*	66%*	39%*	84%*
Not confident	78%	33%*	33%*	58%*	15%*
*Confidence can afford major medical costs*
Confident	12%	65%*	45%*	27%*	67%*
Not confident	86%	32%*	54%*	72%*	32%*
*Worry over health care costs have had major effect on…*
Family relationships	21%	13%	—	—	3%*
Ability to sleep	24%	16%	—	—	5%*
Job performance, family relationships, or ability to sleep	36%	18%*	13%*	17%*	6%*
*Medical Bill Outcomes*
Has outstanding medical bills	45%	23%*	31%*	37%	22%*
Any problem paying medical bills	53%	24%*	26%*	36%*	16%*
Problem with medical bills led to using up savings	27%	10%*	13%*	—	9%*
Problem with medical bills led to difficulty paying for basic necessities	30%	15%*	13%*	—	6%*
Problem with medical bills led borrowing money	27%	12%*	11%*	—	5%*
Problem with medical bills led to being sent to collection	31%	13%*	15%*	24%	8%*
*General financial security*
Generally financial insecure	66%	55%	38%*	43%*	19%*
Somewhat/very difficult to pay for necessities	64%	61%	42%*	53%	22%*
Somewhat/very difficult to save money	85%	82%	68%*	69%*	47%*
Somewhat/very difficult to pay off debt	68%	67%	52%*	61%	36%*
Moved in past year to save money	38%	17%*	28%	25%	7%*
Increased debt in past year to pay bills	29%	31%	27%	29%	16%*
Used savings in past year to pay bills	44%	25%*	44%	30%	31%*
NOTES: Don’t Know and Refused responses are not shown. The “Other Insured ≥ 138% FPL” category is predominantly privately insured people with incomes greater than 138% of poverty, but also includes Medicare enrollees, those who don’t know if they are insured, those who are insured, but refused to answer with what, those waiting for coverage, and other categories of insurance. NA: Not applicable. “–“: Estimates with relative standard errors greater than 30% or with cell sizes less than 100 are not provided. * Estimate statistically significantly different from uninsured estimate at the 95% confidence level. SOURCE: 2014 Kaiser Survey of Low-Income Americans and the ACA.

Table A4: Reasons Why Uninsured Adults in Missouri Lack Coverage and Plans to Obtain Coverage
	Uninsured ≤ 138% FPL	Uninsured ≥ 138% FPL
*Reasons why uninsured*
Too Expensive	65%	58%
Opposed to ACA/Prefer to pay penalty/Don’t need it	7%	19%
Told ineligible	7%	—
Unemployed/Work doesn’t offer/not eligible through work	10%	—
Other/Immigration status/Don’t know how to get it	11%	—
*Attempts at obtaining insurance*
Tried to get Medicaid or Marketplace coverage	46%	35%
Did not try to get Medicaid or Marketplace coverage	54%	64%
Of those who tried to obtain Medicaid or Marketplace Insurance, did so by…
Signing up on healthcare.gov or state HIM website	46%	—
Visiting a state Medicaid agency	57%	—
Calling a toll-free or 1-800 number for help	46%	—
Going to a community agency, school, church, or library	19%	—
Going to a hospital, clinic, or doctor, or other health care provider’s office for help applying	33%	—
Contacting a health insurance broker	13%	—
Tried to apply using more than one pathway	67%	—
Of those who tried to obtain Medicaid or Marketplace Insurance, found difficulty…
Finding out where to apply	43%	—
Filling in the information requested in the application	34%	—
Assembling all the required paperwork	36%	—
Submitting the application	38%	—
At least one aspect of the applying was difficult	71%	—
All aspects of applying were difficult	9%	—
Tried to obtain Medicaid or Marketplace Insurance, but could not because…
Told ineligible	48%	—
The application is still pending	16%	—
Coverage is too expensive	22%	—
Other reason	13%	—
Future Coverage
Planning on getting coverage in 2015	41%	43%
Not planning on getting coverage in 2015	42%	46%
Don’t know if getting coverage in 2015	17%	—
Planning on getting coverage in 2015 through
Medicaid/Marketplace	7%	—
ESI	8%	—
Elsewhere/Not sure	26%	27%
Don’t know where getting coverage	0%	0%
Other coverage options
ESI Eligibility
Not part of working family	51%	38%
Firm doesn’t offer coverage	20%	24%
Not eligible for coverage	11%	—
Cannot afford to pay premium/Don’t think they need coverage/Some other reason	16%	22%
NOTES: Don’t Know and Refused responses are not shown. “–“: Estimates with relative standard errors greater than 30% or with cell sizes less than 100 are not provided. * Estimate statistically significantly different from uninsured estimate at the 95% confidence level. SOURCE: 2014 Kaiser Survey of Low-Income Americans and the ACA.

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Being Low-Income and Uninsured in Missouri: Coverage Challenges during Year One of ACA Implementation

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