MO Charged $11 Million for ACA Tax

The Affordable Care Act (ACA) instituted a new tax on insurance companies that is forcing Missouri to pay an additional $11 million to operate our managed care Medicaid program. The ACA tax, which affects all companies defined as insurers by the federal government, is due for the first time at the end of September.

Missouri pays managed care companies a fixed rate to provide healthcare to Medicaid recipients in certain regions of the state. The $11 million tax has been passed on to Missouri because the federal government requires states to pay managed care companies actuarially sound rates.

Missourians have rejected the implementation of the ACA at the ballot box twice. Voters approved a measure designed to block the federal government from forcing individuals to purchase health insurance and a proposition prohibiting state agencies from setting up a health insurance exchange. Yet the state is still suffering the consequences of this law.

Moreover, departments are slow to tell the legislature about how the ACA is impacting Missouri citizens and the state’s budget. The Department of Social Services (DSS) did not voluntarily tell the General Assembly about the tax. We had to question them about it at the September 8 Appropriations – Health, Mental Health, and Social Services committee hearing.

I have asked DSS for a list of the ways the ACA affects our state. We may not be able to change federal policy, but Missourians deserve to know, especially since there is a push to further entangle Missouri with the ACA by expanding Medicaid.

At the September 8 hearing, the committee also heard testimony from a representative of Great Circle, which offers behavioral health services to children and families, on legislation that has improved our state’s foster care system. House Bill 1453, sponsored by former Speaker of the House Catherine Hanaway, mandated that the state’s Children’s Division become accredited and required the state to partner with private, accredited entities to manage foster care cases. In the ten years that this law has been in place, the state and private entities have introduced better ways of supporting and serving children in foster care, including a greater emphasis on trauma informed care and evidenced based practices.

Private entities that manage foster care cases must present metrics to the state to remain a partner. This emphasis on measurable outcomes allows us to effectively track their progress and identify areas that may need improvement. More state programs should follow suit by calculating and publishing performance data to keep them accountable to legislators and citizens.

The Appropriations – Health, Mental Health, and Social Services committee will hold another oversight hearing on September 29. Regular hearings are essential because questioning departments is often the only way to bring pertinent information to light, and this is an essential element of transparency.