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The open enrollment period for Affordable Care Act plans ends Jan. 16. With enhanced subsidies due to expire on Dec. 31, many Missourians are weighing their options for coverage in 2026 (krisanapong detraphiphat\/Getty Images).<\/p>\n
Until last year, Roberta Ross-Fisher had never been in a hospital except to visit friends and family.<\/span><\/p>\n The self-employed higher education consultant from Franklin County was so diligent about cleaning her teeth she had a gum graft several years ago to repair where she overbrushed.<\/span><\/p>\n Then, on May 5, 2024, she received a phone call. She had cancer in her lower jaw.<\/span><\/p>\n She took time off work and underwent surgery to remove the cancer and reconstruct her mandible with bone from her fibula. Now in remission, she gets CT scans and sees her oncologist every few months.<\/span><\/p>\n \u201cThat\u2019s non-negotiable, whether I have insurance or whether I don\u2019t,\u201d Ross-Fisher said.<\/span><\/p>\n What is also non-negotiable is the premium she\u2019ll pay to remain in a health insurance plan she purchases through <\/span>the federal marketplace<\/span><\/a>. This year, it\u2019s $295 per month. Next year, if Congress extends current subsidies, it will be $479.\u00a0<\/span><\/p>\n And if the subsidies go away Jan. 1, the price will be $1,216 per month, a 312% increase.<\/span><\/p>\n It is enough to give her pause, despite needing cancer follow-up care. Ross-Fisher in 2026 will qualify for Medicare, the federal insurance program for older and disabled adults.<\/span><\/p>\n \u201cI\u2019ve been having conversations with my husband,\u201d she said. \u201cWhat do I do? I\u2019m now a cancer patient. Do I risk going for six months without insurance?\u201d<\/span><\/p>\n The conversation Ross-Fisher is having with her husband is the same one being held in thousands of households across Missouri.<\/span><\/p>\n The open enrollment period for Affordable Care Act plans opened Nov. 1 and ends Jan. 16. For some, the extra costs for 2026 will mean they go without coverage.\u00a0<\/span><\/p>\n Others may look for alternatives, such as <\/span>Missouri Farm Bureau<\/span><\/a> health coverage that does not qualify as an insurance plan under federal definitions. Backers promised it would be cheaper when lawmakers passed the law this year, but no one interested in buying into the plan will know if they will truly save money until it launches Jan. 1.<\/span><\/p>\n And the uncertainty makes financial planning more difficult for medical providers.<\/span><\/p>\n Care for people on marketplace plans represents about 2% of the revenue for University of Missouri Health Care, said Greg Damron, chief financial officer for MU Health Care in Columbia.\u00a0<\/span><\/p>\n \u201cThat doesn\u2019t sound like a lot,\u201d Damron said, \u201cbut if you think about it, when you\u2019re trying to get to a 4% margin or something, 2% of your revenues is kind of a big deal.\u201d\u00a0<\/span><\/p>\n <\/b><\/p>\n \t<\/p>\n For 43 days, Democrats in the U.S. Senate <\/span>used the filibuster<\/span><\/a> to keep the federal government shut down in an effort to preserve the enhanced subsidies enacted as a <\/span>COVID-19 emergency measure<\/span><\/a> in 2021.\u00a0<\/span><\/p>\n Under the 2010 Affordable Care Act, the actual premiums paid by lower-income people purchasing individual health plans through the federal marketplace were capped as a share of their income. At the lowest end of the income scale, the <\/span>cap was 2.1%<\/span><\/a>, rising to 9.96% for people between three and four times the federal poverty level, or between <\/span>$46,950 and $62,600<\/span><\/a> for a single person.<\/span><\/p>\n The enhanced subsidies reduced those caps so people at the lowest end paid no out-of-pocket premiums and no person purchasing an individual plan <\/span>paid more than 8.5%<\/span><\/a> of their income.<\/span><\/p>\n The enhanced subsidies expire Dec. 31. The U.S. Senate will vote in December on a bill extending the subsidies, but there\u2019s no promise of a similar vote in the U.S. House and no indication President Donald Trump would sign it if passed.<\/span><\/p>\n Missouri health premiums to rise as much as 30% for 2026 amid uncertainty over subsidies<\/a><\/p>\n<\/blockquote>\n One result of the enhanced subsidies was dramatic growth in the number of Missourians covered by ACA plans at the same time <\/span>Medicaid enrollment declined<\/span><\/a> as eligibility reviews began following a freeze tied to the COVID-19 emergency.<\/span><\/p>\n In 83% of Missouri counties, an <\/span>analysis from Washington University<\/span><\/a> shows, new enrollments in marketplace plans exceeded the decline in Medicaid enrollment.<\/span><\/p>\n \u201cThe rapid growth in marketplace enrollment likely was influenced by enhanced premium tax credits (EPTCs), which were passed in 2021 and significantly lowered the out-of-pocket premiums recipients pay for the marketplace plans,\u201d the analysis states.\u00a0<\/span><\/p>\n There are more than <\/span>417,000 people in Missouri<\/span><\/a> covered by marketplace plans, up from 257,000 in 2023. Faced with <\/span>double-digit increases<\/span><\/a> in base premiums and the loss of enhanced subsidies, many may drop health insurance entirely.<\/span><\/p>\n \u201cWithout that premium support, the belief out there is that it\u2019s largely going to hit younger, lower-income people,\u201d Damron said. \u201cThey\u2019re likely going to be the folks that also decide to opt out of insurance coverage altogether.\u201d<\/span><\/p>\n <\/b><\/p>\n \t<\/p>\n Small businesses that provide health insurance are also facing tough choices \u2014 whether to pass more costs to employees or stop offering coverage altogether, said Brad Jones, Missouri lobbyist for the National Federation of Independent Businesses.<\/span><\/p>\n The small group rates approved this fall by the Missouri Department of Commerce and Insurance show <\/span>average increases of 10% to 19%<\/span><\/a> for 2026.<\/span><\/p>\n \u201cFor a business with seven or eight employees, it is like buying a suit off the rack,\u201d Jones said. \u201cThey don\u2019t have any negotiating power.\u201d<\/span><\/p>\n For almost 40 years, the cost of health insurance has been No. 1 among the \u201c10 most severe problems for small business owners\u201d identified by the <\/span>National Federation of Independent Businesses<\/span><\/a>.<\/span><\/p>\n Conducted every four years, the Small Business Problems and Priorities survey ranks 75 issues facing businesses with fewer than 100 employees. The cost of health insurance was cited as an issue by 41% of employers, more than 20 percentage points higher than the second problem on the list, the cost of inventory and supplies.<\/span><\/p>\n In 2000, the report shows, almost half of all small businesses offered health insurance, with an average annual cost of about $2,600 per employee. Now, with the average cost greater than $8,000 per employee, fewer than one in three small employers provide coverage.<\/span><\/p>\n \u201cWhen premiums go up, there are hard decisions that have to be made,\u201d Jones said. \u201cDeductibles go up to keep costs down. There are a number of things businesses try to do and not drop it all together.\u201d<\/span><\/p>\n The smallest businesses may not survive if owners decide to seek employment that provides health coverage, said Marie Murphree, executive director of the Kirksville Area Chamber of Commerce.<\/span><\/p>\n \u201cWe might start seeing some of those go away,\u201d said Murphree, who estimated that a fifth of the about 300 businesses in her chamber are individual entrepreneurs.<\/span><\/p>\n Higher premiums could be especially damaging in rural areas, Murphree said, where \u201cwe already see businesses who struggle to recruit people.\u201d\u00a0<\/span><\/p>\n \u201cNow one of the recruitment tools that you have,\u201d she said, \u201cyou really can no longer offer, because it\u2019s out of your ability to afford it.\u201d<\/span><\/p>\n Rob Gilligan, president of the Cape Girardeau Area Chamber of Commerce, said the \u201cvast majority\u201d of the chamber\u2019s 800 members have 50 employees or less. While he said they\u2019d like to offer insurance to employees, the cost can be \u201cprohibitive\u201d with fewer staff to share costs.<\/span><\/p>\n The Missouri Chamber of Commerce and Industry offers an insurance plan to businesses with fewer than 50 employees allowing them to pool together to share risk and ideally get more competitive rates.<\/span><\/p>\n Gilligan said that while some small business owners have expressed that they will be looking at higher deductible plans in anticipation of much higher premiums this year, they\u2019ve already had to adapt to rising insurance costs in recent years.<\/span><\/p>\n \u201cYou just know that the cost of health is one of those things that\u2019s going to continue to rise,\u201d said Gilligan, whose chamber offers insurance to its employees. \u201cWe just have to kind of know that every year we\u2019re going to look at that as something that we need to plan for and adapt to.\u201d<\/span><\/p>\n <\/b><\/p>\n \t<\/p>\n The Affordable Care Act mandates that every plan offered by an employer and every plan on the health care marketplace provide minimum essential coverage. The <\/span>10 essential benefits<\/span><\/a> range from hospitalization and office visits to maternity care, mental health treatments and preventive tests.<\/span><\/p>\n This year, legislators passed a law allowing the Missouri Farm Bureau to offer coverage that does not include all 10 benefits.\u00a0<\/span><\/p>\n Many farmers and other members of the Farm Bureau, proponents said, are uninsured because they can\u2019t afford to buy an individual plan on the marketplace or make too much money to qualify for subsidies.<\/span><\/p>\n Members will be able to start buying plans on Jan. 2, with coverage set to begin Feb. 1, said Garrett Hawkins, president of the Farm Bureau. The website will be available starting Dec. 1, he said.<\/span><\/p>\nEnhanced subsidies<\/h4>\n
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Small business worries<\/h4>\n
Farm Bureau alternative<\/h4>\n
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