Marketplace Chasm: Failed Medicaid Expansion Leaves Gaping Hole

By the end of January, about 9 million Americans had signed up for health insurance, a mandate under the Affordable Care Act (ACA). February tallies logged about 3.3 million people who received a health insurance plan via a state exchange or through

Other figures conclude that 6.3 million people received new or renewed Medicaid coverage, and another 3 million young adults gained coverage through their parents’ plans.

In Lafayette County, the Health Care Collaborative (HCC) of Rural Missouri continues to help people enroll in Missouri’s federal exchange. Julie Bartley, HCC’s program manager and an ACA certified application counselor (CAC), said she has met with 50 people, with about 20 enrolling in a health plan through Bartley said she has sat down with people from Lexington, Odessa, Wellington, Higginsville, Richmond, Waverly and even Blue Springs. “They are usually favorably surprised by the rates,” Bartley said.

In order to qualify for a health plan, and receive a subsidy on the health insurance marketplace, individuals and families must fall between 100 to 400 percent of the federal poverty level (FPL). This means that an individual’s annual income cannot exceed $45,960 to qualify for a subsidy, and income for a family of four must not exceed $95,200 to qualify. Incomes up to 250 percent FPL, or $58,875 for a family of four, may be available for cost-sharing subsidies to reduce out-of-pocket costs. Those who earn less than $11,670, or under 100 percent FPL, do not qualify for a health insurance plan through the marketplace, but can request a waiver to avoid penalty.

Missouri’s Medicaid continues to be a sore spot. “The fact that Missouri did not expand Medicaid has been the biggest challenge in all of this,” Bartley said. “I have worked with at least 10 people who fell below 100 percent of the federal poverty level—so they didn’t qualify for a subsidy and couldn’t afford to purchase insurance.”

Bartley also met with a woman, with a pre-existing condition, who could only find part-time work and because of her condition, was limited in what type of work she could do. Her annual income was slightly below 100 percent FPL, so she didn’t qualify for a plan on the marketplace.

In another instance, Bartley tried to enroll a blended family who had their own children, plus are raising the children of a deceased sibling. “These parents are working hard to keep all of these kids together,” she said.

Because of the parents’ income, the family had no insurance and didn’t qualify for a subsidy. “The children got covered, but the rates were just too high for mom and dad. The fact that Missouri did not expand Medicaid has created a large gap, and I feel like many people were let down. The hardest thing I have to do is to tell someone that they fall beneath the FPL threshold, and that the insurance they thought they were going to get is financially out of their reach,” Bartley said.

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HCF's Local Health Buzz Blog aims to discuss health and health policy issues that impact the uninsured and underserved in our service area. To submit a blog, please contact HCF Communications Officers, Jennifer Sykes, at


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