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Opinion: Coverage under the Affordable Care Act critical for Missourians


The Affordable Care Act (ACA) has been the law of the land for 10 years, transforming our health care system and extending critical health insurance coverage to millions of people in Missouri and nationally. Not only has it improved our health system, it has also improved health outcomes and increased access to care for women, children, people of color, and rural communities. The ACA has moved millions of people from being uninsured, codified protections for people with preexisting conditions, eliminated gender inequality in health insurance, and allowed young people to remain on their parents’ insurance for longer. It has also enhanced protections for people with disabilities, required employers to accommodate breastfeeding mothers, lowered costs for seniors, and strengthened rural care. The Affordable Care Act has improved health equity and saved lives.

The catastrophic impacts of the COVID-19 pandemic, however, have revealed how fragile our health system still is. Missouri ranks No. 44 in the nation for public health funding. Long-entrenched racial disparities leave Black and brown communities disproportionately vulnerable to various health challenges. Since 2014, 10 rural hospitals have permanently closed, due at least in part to our failure to expand Medicaid. For far too many elected officials, health and health care have become political footballs rather than matters of life and death.

The holes in our health care system left us vulnerable to the deadly coronavirus pandemic. The pandemic, in turn, has set public health back even more and widened systemic inequities. It has stretched our health system to its limits and strained access and delivery of care. Thousands of Missourians have lost their jobs, incomes, and health insurance due to COVID-19. Black and brown Missourians have suffered a disproportionate number of infections, hospitalizations, and death. We have lost more than 250,000 Americans and more than 3,500 Missourians, and many have lost loved ones or become ill themselves. Some who have contracted COVID-19 and survived have devastating health effects months after “recovery.” No individual and no sector have been immune from the devastating effects of the pandemic, and there is no end in sight.

The U.S. Supreme Court recently heard oral arguments in California v. Texas, the latest high-profile attempt to overturn the Affordable Care Act, to which Missouri is a party. The technical challenges to the law are nebulous, far-reaching, and lack considerations for the lived reality of those whose health hangs in the balance. This decision threatens critical care at a critical time.

Overturning the ACA would have disastrous consequences, which would be felt deeply in Missouri and nationally. More than 20 million people would immediately lose coverage, and even more would lose protections for preexisting conditions, including COVID-19. Women would lose access to maternal health services and preventative coverage without out-of-pocket costs, young adults would no longer be able to remain on their parents’ insurance, and Medicare patients would again face unaffordable prescription drugs. States stand to lose as much as $135 billion in federal funding for Medicaid, the Health Care Marketplace, and Children’s Health Insurance Program (CHIP). Over the past 10 years, the health system has changed and adapted to operating under the ACA. If eliminated suddenly, there would be irreparable damage to the entire system, affecting patients, providers, hospitals, and insurance companies.

This past August, Missourians said they wanted health care coverage for themselves and their neighbors, and our state became the 39th to pass Medicaid expansion under the Affordable Care Act. When voters decisively approved the measure, they sent a clear message that they want to expand coverage through the ACA, not further restrict it or upend it altogether.

As we write this, there are almost 2,600 Missourians hospitalized for COVID-19, with 608 people in the intensive care unit and 310 people on ventilators. In the past seven days, there have been more than 27,000 new COVID-19 cases statewide and almost 70 new deaths. By the time you read this, the numbers will be higher. Missouri should not be party to the destruction of the Affordable Care Act, especially during an ongoing and worsening public health crisis. It is not what Missourians want, and our health and lives are on the line.