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

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.
Policy Implications

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.