Young children lost health insurance faster in Missouri than in any other state

Georgetown University researchers had some bad news for the Show-Me State this past week.

In a study published Monday, researchers found the percentage of young children without health insurance rose faster in Missouri than in any other state from 2016-2018, putting the state in the vanguard of a troubling nationwide trend.

After two years in which Missouri cut the percentage of kids ages 0-6 without insurance nearly in half, its uninsured rate jumped from 3.6 percent to 5.3 percent from 2016 to 2018.

That took the state from having the 28th-best rate to the 39th-best rate among the 50 states and the District of Columbia and earned it a dubious distinction as one of 11 states showing statistically significant increases in the rate and raw number of uninsured young children.

The national uninsured rate jumped from 3.8 percent to 4.3 percent over the same time period.

The researchers at Georgetown’s Health Policy Institute lamented the increases, which followed years of national improvements, because the children concerned are at ages when their brains and bodies are growing fast and need regular checkups to ensure they’re growing properly.

They called the period before a child enters kindergarten a “critical window to address any developmental delays or health conditions before they escalate into greater challenges” and added that having health coverage as a youngster is linked to better health, educational and economic outcomes as an adult.

Casey Hanson, a spokeswoman for Kids Win Missouri, said the cost of checkups without coverage can make kids miss out on those benefits, which ultimately hurts the state.

“This is something that we’re going to be dealing with for a long time to come,” she said.

The researchers didn’t comment specifically on why Missouri kids are losing insurance, but they addressed multiple hot-button issues at the center of political debate here.

For instance, they said the declines are likely driven by declining enrollment of children in Medicaid programs. Caseload numbers show roughly 47,000 children were removed from Missouri’s rolls from January 2016 to December 2018.

The vast majority of that decline took place in 2018 and continued into 2019, prompting months of Missouri lawmakers arguing over why.

Democrats including House Minority Leader Crystal Quade of Springfield have demanded investigations into the system, citing news reports of people being kicked off coverage despite meeting requirements for benefits and struggling to re-enroll.

Republicans, on the other hand, have cast the declines as evidence that a robust economy is helping low-income people make more money than Medicaid allows.

After pressure built for an investigation over the summer, House Speaker Elijah Haahr, R-Springfield, said that from 2014 to 2018, the state had failed to properly vet its rolls and therefore had renewed coverage for people who weren’t eligible and needed to be removed.

Rep. David Wood, a Versailles Republican who chairs a committee overseeing the Department of Social Services’ budget, stood by that explanation in an interview Friday.

He said that when the federal insurance marketplaces launched in 2013 and required people to check if they were eligible for Medicaid, so many applications came in that the department couldn’t verify them all.

“We were getting so many applications that we approved them and went back and verified later,” he said.

He added that his committee is working to address legitimate concerns with application paperwork being overly complex and state call centers taking too long to answer calls for help.

Democrats took a different tack.

Rep. Sarah Unsicker, D-Shrewsbury, cited the study as a reason to pass a bill guaranteeing children at least one year of continuous coverage who enroll in Medicaid to avoid disruptions to their care.

"Children's health insurance rates have been dropping at an alarming rate, and children who have health care coverage continuously throughout the year remain healthier,” Unsicker said in a news release Thursday. “My bill would help our kids attain better health outcomes.”

The Missouri Democratic Party used the study in a fundraising email, telling supporters that "Missouri is now number one in the nation for uninsured young children" and asking for $10 to elect candidates "who will fight to make sure no child goes without health care in this state."

(Fact check: Missouri had the biggest increase in the percentage of uninsured children from 2016-18, but Alaska had the highest percentage of uninsured children in 2018 at 9.2 percent. Missouri had the 13th-highest rate at 5.3 percent.)

Progressives likely also nodded their heads at another finding in the Georgetown study: that young children in states that hadn’t expanded Medicaid — like Missouri — are worse off than those in the 32 states that had.

The researchers said that in addition to lacking health insurance themselves, young children may also live with uninsured parents, whose own struggles could keep them from fully contributing to their child’s development.

A.J. Bockelman, who is managing the campaign to put Medicaid expansion on the Missouri ballot in 2020, said the report “underscores what we’ve known for a long time.”

“Too many Missouri kids, rural residents, and hardworking adults don’t have access to healthcare and the problem is getting worse,” he said in an emailed statement. "It’s time to give Missouri voters the chance to decide what’s best when it comes to the health of our communities.”

If passed, expansion would allow anyone earning less than 138% of the federal poverty level — less than $18,000 a year for an individual or $30,000 for a family of three — to qualify for the program.

An early estimate from Washington University researchers said more than 200,000 people, and perhaps 40,000 children, would become eligible.

Republicans are generally opposed to the idea, with Haahr telling reporters in September that expansion would “blow a sizable hole in the state budget.”

Rep. Steve Helms, another Springfield Republican, has said the cost could lead to cuts in K-12 educations.

The Washington University researchers disagreed, estimating that expansion could save the state $932 million by 2024.

The study also suggested expansion would drive help down costs by helping low-income patients address problems before they become expensive emergencies.

Another analysis conducted by the state auditor’s office said the state could see anything from at least $200 million in increased costs to savings of $1 billion by 2026.