This article first appeared in the St. Louis Beacon, Aug. 23, 2013 - It looked like a useful federal announcement, the kind that state education officials routinely pass on to local school districts and the public. The item was titled “Affordable Care Act – Back to School Materials.” It announced that the U.S. Department of Education was supporting efforts to inform the public about full implementation of the Affordable Care Act.
The Missouri Department of Elementary and Secondary Education had begun distributing the information through its electronic mailbag page. By Wednesday, however, the item had vanished from the mailbag, a casualty of Proposition E. That’s the ballot measure, passed last year, which says state workers and agencies could be sued if they took any action on federal health-reform matters without the approval of the Missouri Legislature or a vote by Missouri residents.
DESE officials removed the item from its website following a Beacon inquiry about whether the announcement came under Prop E rules. A DESE official explained that the agency routinely uses its electronic mailbag to forward information at the request of the U.S. Department of Education.
“However, staff was unaware that this specific request by the U.S. Department of Education was directly impacted by the state law prohibiting the dissemination of information related to the ACA. Therefore, the department immediately removed the item.”
The announcement from federal education officials focused on the need for kids to have access to good health care. It included a link to the federal agency’s website where viewers were given access to more information, including a brief video: Ten ways to promote new insurance opportunities
The federal education announcement said: "The U.S. Department of Education is supporting efforts to inform the public about full implementation of the Affordable Care Act. Too often, children who are uninsured encounter obstacles that prevent them from becoming fully engaged in the classroom, on the playing field and in other extracurricular activities; thus preventing them from getting the most out of their education."
DESE's decision to remove the link marked at least the second time that Proposition E has led a state agency to back away from an activity that could be perceived as promoting ACA.
Earlier, some local health departments said fear of lawsuits have made them reluctant to host meetings, distribute information or educate uninsured clients who might need help in wading through the exchange enrollment process.
Ryan Barker, vice president of health policy at the Missouri Foundation for Health, said recently that some county health departments might be sympathetic to educating the public about the law but are concerned about the potential of being sued under Prop E. It remains unclear how many health departments will refuse to disseminate ACA information.
Meanwhile, groups across Missouri are gearing up for a major campaign to publicize the benefits and advantages of ACA. Last week, the Department of Health and Human Services also got the ball rolling in Missouri by designating two Missouri organizations to help educate consumers about the insurance exchange, which is set to begin processing claims on Oct. 1 for consumers eligible for subsidies to buy insurance under ACA rules.
In addition, Barker and others are holding a meeting next week in Columbia to plan strategy and announce MFH-funded grants to groups that will help to publicize and promote the insurance exchange for Missouri.
Such groups are doing extra work in Missouri for several reasons. First, Prop E halted the creation of an insurance exchange, an Orbitz-like system through which consumers are supposed to be able to buy private health insurance. Second, the legislative inaction means federal officials will design Missouri’s exchange. Federal officials have yet to say what that system will look like, and it remains unclear which private insurers will participate and what the cost of insurance premiums will be.
In addition, Missouri decided not to expand its Medicaid program to allow the state to draw down millions of dollars in federal funds to make Medicaid available to poor consumers. Failure to expand Medicaid means residents with incomes below the federal poverty level – roughly $23,500 for a family of four -- will be shut out of the new federal health insurance program.
State lawmakers, some of whom oppose Medicaid expansion for philosophical reasons, predict changes are likely to be made in Missouri’s Medicaid program in the next legislative session. Proponents of ACA are hoping those changes will include expanding Medicaid to make more residents eligible for health insurance under ACA.
