Missouri advocates praise ruling for health-care subsidies

JEFFERSON CITY, Mo. -- Missouri health-care advocates praised a U.S. Supreme Court ruling Thursday that backs nationwide subsidies under President Barack Obama's health-care overhaul, while Republican leaders called the law flawed and renewed calls to ax it.

Of those receiving subsidies, 6.4 million people were at risk of losing that aid because they live in states that did not set up their own health-insurance exchanges.

That includes nearly 200,000 Missourians, according to Families USA, a not-for-profit agency in support of the Affordable Care Act. The group also estimated 19,000 people in the 8th Congressional District, which covers Southeast Missouri, were at risk of losing subsidies.

"These Missourians will not have to choose between health insurance and other basic needs," Missouri Foundation for Health policy director Ryan Barker said.

Missouri is one of 34 states that use the federal health care exchange -- a federally run website where residents can buy health insurance.

People can qualify for tax credits to subsidize their insurance costs.

The state's reaction to the Supreme Court ruling upholding those subsidies underscores an already tense partisan divide between state Republicans and Democrats more generally over the Affordable Care Act.

Missouri's GOP members of Congress generally expressed disappointment in the decision.

U.S. Rep. Vicky Hartzler said it will hinder efforts to upend the health care law, which U.S. Sen. Roy Blunt said was "flawed."

Blunt said he'll fight to replace the current program "with a patient-centered system that lowers costs, increases choices and provides greater access to quality care."

Democratic leaders joined advocates in expressing relief for keeping the status quo.

But many also used the ruling as fuel in their long-running efforts to expand Medicaid eligibility for low-income adults in the state -- another way, some argue, to increase access to health insurance.

Missourians above the poverty level can qualify for subsidies through the federally run insurance exchange. Medicaid is intended to cover health care for the country's poorest residents. Missouri's current Medicaid eligibility for adults is at 19 percent of the federal poverty level.

Under the terms of Obama's health-care law, states can receive enhanced federal funding if they raise eligibility for adults earning up to 138 percent of the federal poverty level.

Protesters chanted and marched several times at the Missouri Capitol this session in hopes of spurring lawmakers to do just that. But Republican leaders repeatedly said expansion was a non-starter and blocked Democratic efforts to broaden eligibility.

While commending the Supreme Court decision, Democratic Gov. Jay Nixon also criticized lawmakers for their "inaction on Medicaid."

"There are no more excuses for ... denying 300,000 working Missourians the opportunity to access affordable health-care coverage through Medicaid expansion," Nixon said in a statement.