The recently enacted American Rescue Plan Act of 2021 (ARP) includes new large financial incentives for states to extend health insurance coverage to low-wage workers and other adults earning less than $17,775 a year.¹ These incentives apply to regular spending in a state’s Medicaid program and offer a five-percentage point across the board increase in the federal share for a 24-month period after the state extends coverage. Missouri is eligible for this funding because voters approved expansion in a referendum last year but it has not yet been implemented. The Kaiser Family Foundation estimates that Missouri’s budget would see a net gain of $1.15 billion over a two-year period when the state begins covering adults in Medicaid.² Approximately 247,500 uninsured non-elderly adults will gain health insurance.³
This fact sheet examines which workers and industries will benefit from the expansion of Medicaid coverage.4 Industry sectors in Missouri with the largest percentage of low-wage uninsured workers are hospitality, retail, and health care and social assistance, accounting for 49 percent of low-wage workers without insurance (see Table 1). The most common jobs for low-wage, uninsured workers are cashiers, cooks, laborers and movers, and maids and housekeeping staff (see Table 2).
This map lists the twenty-one counties with the highest proportion of uninsured workers, each with more than one in five non-elderly employed adults of all incomes lacking insurance. All of these counties except for McDonald County are classified as rural counties. The uninsured rate for all non-elderly adult workers varies considerably across the state of Missouri, ranging from 32.5 percent in Scotland County to 5.2 percent in St. Charles County. Hover over the map to see the uninsured rate in each county.
¹For more information on the provisions of the law, see E. Park and S. Corlette, “American Rescue Plan Act: Health Coverage Provisions Explained” (Washington DC: Georgetown University Center for Children and Families and Center on Health Insurance Reform, March 2021), available at https://ccf.georgetown.edu/2021/03/11/american-rescueplan-act-health-coverage-provisions-explained/.
²R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending” (Washington DC: Kaiser Family Foundation, March 2021), available at https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-toadopt-the-aca-medicaid-expansion-implications-for-state-spending/.
³Earlier estimates from the Office of the Governor project enrollment of 274,500 in the first year. “Medicaid Expansion Enrollment and Eligibility Update: Geographic Distribution of Medicaid Enrollees” (Saint Louis University Center for Health Law Studies & Washington University Center for Health Economics and Policy, March 2021), available at https://publichealth.wustl.edu/wp-content/uploads/2021/03/County_Enrollees_factsheet_final_v.2.pdf.
4 Contact authors for more information on sources of data and methods. All data are from American Community Survey 2019 most from the Public Use Microdata Sample; county data calculated from American Community Survey five-year (2015-2019) prepared tables.