The uninsured rate in Missouri has dropped significantly, according to a new analysis by the Center for Advancing Health Services, Policy & Economics Research at Washington University in St. Louis.
In 2023, 92.5% of Missourians had health insurance, leaving just 7.5% uninsured, based on data released Sept. 12 by the U.S. Census Bureau. This marks a notable decrease from 10% uninsured in 2019, prior to Missouri’s Medicaid expansion, and 13% uninsured in 2013, when the federal Affordable Care Act (ACA) took effect.
The bureau’s Sept. 12 report provides the first comprehensive look at health insurance coverage in Missouri through 2023, capturing both private and government program enrollments, including Medicaid. Economic factors, such as recessions and the COVID-19 pandemic, also have influenced health insurance trends in Missouri between 2008 and 2023.
“The steady decline in the uninsured rate over the past decade reflects the profound impact of major health policy reforms, including the implementation of Obamacare, the ACA, and Missouri’s Medicaid expansion in 2021,” said Timothy McBride, center co-director and the Bernard Becker Professor at WashU’s Brown School.
McBride said that while the ACA and Medicaid expansion explain most of the drop in the number of uninsured, one factor working in the other direction is the Medicaid “unwinding” process in Missouri. Under the unwinding, which began in June 2023, the state of Missouri reviewed eligibility for Medicaid and disenrolled individuals who no longer qualify after the COVID-19 public health emergency ended.
“When the pandemic started in January 2020, the federal government told the state they could not disenroll anyone who had enrolled in Medicaid after the pandemic started,” McBride said. “So the pandemic paused annual Medicaid reverifications, preventing disenrollment and pushing nationwide Medicaid enrollment to record highs. But once the unwinding began, it has contributed to a drop in the number of people who are insured and rise in the uninsured. The numbers reported by the census capture only about half of the unwinding process.”
Missouri’s Medicaid expansion, which began in July 2021 after delays, played a key role in reducing the uninsured rate. While more than 300,000 Medicaid recipients lost coverage during the 2023 “unwinding” process, preliminary data indicates that only half of that impact is reflected in the 2023 numbers.
From 2019 to 2023, the number of uninsured Missourians fell from 604,000 to 458,000, a reduction of 146,000. Over the same period, Medicaid enrollment surged by 203,000, driven by the expansion and pandemic-related public health measures. Despite this, private insurance saw a decrease of 30,000, while Medicare coverage grew by 46,000.
The long-term impact of the ACA is evident, McBride said. Since 2013, the number of insured Missourians has risen by 478,000, while the uninsured population dropped by 315,000. Medicaid enrollment surged from 867,200 in 2013 to 1.48 million in 2023, aligning with the decline in the uninsured. Meanwhile, Medicare coverage increased by 190,000, and private insurance grew by 110,000, largely due to employer-sponsored plans.
