Missouri ranks No. 5 in growth of uninsured population

The Missouri Foundation for Health notes that in a five-year national study by the Robert Wood Johnson Foundation, Missouri ranked fifth among the 50 states for the growth of its uninsured population. The number of Missourians without insurance coverage increased 30 percent, to 715,654, between 2001 and 2005. During that same period, the number of employers offering health insurance to employees shrank by 10 percent, according to the study.

Meanwhile, for Missourians in employer-sponsored plans, the average premium per covered employee rose 35.7 percent in the five-year period, while the median income of covered workers rose only 1.46 percent.

The numbers come as no surprise to Richard Ollis, president and CEO of Ollis & Co. Insurors.

“Employers now are being forced to pass along some of the cost of that coverage to their employees, which in some cases cause some of them to opt out of coverage,” Ollis said, with smaller businesses being harder hit than their larger counterparts.

The cost of medical care continues to rise at 10 percent to 15 percent a year, he added, but the biggest factors in escalating costs are the ones that no one is talking about.

“When we talk about the health care crisis, one of the things many people don’t talk about is that we really have a health crisis,” Ollis said. “We as a society create more than 70 percent of our own health conditions as a direct result of our lifestyle.”

Childhood obesity has tripled in the last 10 years, he said, and the typical American is overstressed, doesn’t eat a well-balanced diet, doesn’t get adequate sleep, doesn’t drink adequate amounts of water and doesn’t get enough exercise.

Reform and accountability

No matter who is paying for the health care, any reform that doesn’t make individuals accountable for their health choices is merely passing the buck, Ollis added.

In announcing the results of the five-year study, Missouri Foundation for Health President and CEO Dr. James R. Kimmey said in a news release, “These data confirm findings from other studies that indicate the employment-based approach to providing health coverage is in serious trouble in Missouri and in the country. If it is going to continue to be the method of choice for such coverage, it needs serious restructuring.”

While Ollis agrees that restructuring could have merit, “until we address our lifestyle and our health as a society,” costs will continue to escalate out of control.

The traditional way to address rising costs is to increase deductibles and pass more cost along to the employee in the form of higher premiums and copays. But many businesses have cut as much as they’re willing to, Ollis said. “There’s only so much cost you can cut by trimming and cutting benefits. And what a lot of businesses are looking at as the next step is more of a long-term approach, which involves wellness and using plan design to achieve the goals they want to achieve.”

Plan design creates an incentive for healthy behavior. A two-tier plan, for example, provides one set of benefits for those who participate in wellness-enhancing behaviors – such as exercise and healthy eating – and another, more limited set of benefits for those who don’t.

Ollis & Co. itself utilizes a tiered plan. Employees who commit to specific healthy behaviors, such as exercise and adequate water intake, qualify for a richer benefit plan than those who don’t make the effort.

“Over time, a properly implemented wellness program not only has an impact on health care costs, it also has an impact on soft costs, such as absenteeism, productivity and those types of issues,” Ollis said.

Meaningful reform, he added, would ideally consider wellness measures such as activity level instead of arbitrary measures like height-weight charts.

Access to affordable care

But what becomes of people who are uninsured or, because of either high deductibles or limited benefits, are underinsured?

Those who don’t qualify for private insurance can turn to the Missouri Health Insurance Pool (see box), but rates and deductibles are high. Those driven to seek MHIP coverage may have pre-existing conditions that price them out of traditional coverage, or they may be disqualified from coverage for something as simple as exceeding height-weight guidelines, regardless of their actual state of health.

While employer sponsored plans may offer more favorable terms, high deductibles can be as much of a problem for the individual as no insurance at all. In the Ozarks, at least one provider is responding to that need.

Family Medical Walk-in Clinic, an independent urgent care clinic, launched a non-insurance care program called Affordable Care Solutions in 2007.

ACS is not insurance but a membership program that is marketed to businesses and is also available to individuals. Members pay $50 a month plus a $30 office visit fee that covers their time with the provider, as well as labs, X-rays, sutures and other services provided on site. Sutures alone typically run $300 to $400 in the urgent care setting and as much as $700 to $1,000 in the emergency room, said Tammy Mallow-Elly, Family Medical Walk-in Clinic administrator.

Available for less than a year, ACS recently signed its 400th enrollee, and state and local politicians are taking notice, Mallow-Elly said, noting that because the plan is so revolutionary, it’s hard to measure the significance of the 400-enrollee milestone.

She said that a physician interviewed in the Wall Street Journal last year for a similar program had signed up 100 enrollees in a four-year period, “so we felt 400 members in one year was something to celebrate.”

With locations in Springfield, Nixa and Republic, the Family Medical Walk-in Clinic serves approximately 4,500 patients a month.

“What we’ve seen over time is patients having more responsibility up front with high deductibles, a significant increase in their copays, and limits on what the copay covers and doesn’t cover,” Mallow-Elly said, adding that ACS was a way to recapture the patient base that otherwise couldn’t afford to access services.

MHIP: Last-resort Coverage

The Missouri Health Insurance Pool is a resource of last resort for those who cannot get insurance through the regular market. MHIP offers five plan options, four with deductibles, at $500, $1,000, $2,500 and $5,000 respectively, and one with a health savings account.

Premiums for a male in his 20s range from a high of $345 a month with a $500 deductible to a low of $162 a month with a $5,000 deductible and $208 a month for an HSA. MHIP premiums for a female in her 20s range from $640 a month with a $500 deductible to $286 a month with a $5,000 deductible and $398 for an HSA.

The premiums increase with age: a male in his late 40s would pay $724 a month with a $500 deductible, $363 a month with a $5,000 deductible, and $456 for an HSA. A female in her late 40s would pay $908 a month with a $500 deductible, $460 a month with a $5,000 deductible, and $569 for an HSA.

Source: Missouri Health Insurance Pool