Thousands of residents in southwest Missouri are scrambling to find new doctors after insurance changes left CoxHealth — the region’s largest health system — unavailable for many marketplace patients.
The disruption comes as nearly 350,000 Missourians enrolled in Affordable Care Act marketplace plans this year. That number represents about 5% of all the state’s residents, but it’s actually about 10% lower than a year ago, as Congress letting federal subsidies lapse, meaning insurance premiums for those on ACA marketplace plans skyrocketed.
In Greene and Webster Counties, many patients say they were unable to find plans that include CoxHealth providers, forcing them to switch coverage, change doctors or go without care.The decision affects Springfield, the state’s third-largest city – which is also home to CoxHealth’s headquarters.
CoxHealth said last fall that, “based on current analysis and the uncertainty of the marketplace,” its insurance arm, CoxHealth Plans, would not offer marketplace plans in those counties this year, according to a press release the health system provided to KBIA.
It remains unclear whether any insurer offers marketplace plans that include CoxHealth providers in the area. An spokesperson for Anthem, the nation’s second-largest health insurer, confirmed that company does not., UnitedHealthcare, the largest U.S. health insurance firm, said it offers marketplace plans in Greene County through a CoxHealth competitor, Mercy, but did not directly address CoxHealth.
"It's a scramble"
According to Centers for Medicare & Medicaid Services, nearly 23,000 people in Greene County and about 2,800 in Webster County enrolled in marketplace plans in 2025.
For patients such as Heather Lewis, the change has had immediate consequences.
Lewis, a Springfield social worker, has multiple chronic conditions, including lupus, an autoimmune disease in which the body attacks its own tissues. She relies on four specialists for digestive, kidney and nerve-related care.
For 22 years, Lewis received treatment through CoxHealth. But when she went to renew her insurance last November, she learned none of her doctors would be considered in-network for 2026.
“It was really stressful… knowing it would be hard to find new specialists, and that I might not have care for several months because of waitlists. That was a big blow,” she said.
Lewis said missing care could mean skipping a monthly blood transfusion. She ultimately switched most of her treatment to Mercy.
“I had really good relationships with all of my doctors,” she said. “You build that over time — and now suddenly I have to explain everything to five new people.”
She is still waiting to see some specialists and has been referred to a gastroenterologist in St. Louis — nearly a three-hour drive away.
Others report similar challenges.
David James, a tattoo artist in Marshfield – a town just northeast of Springfield – has Crohn’s disease and requires an injection every eight weeks to manage his condition. He also had to leave CoxHealth and switch to Mercy, where he encountered long wait times.
“I was so close to getting my injection, which was a scramble,” he said. “They had been inundated with other patients coming in because of this cancellation of coverage.”
When he eventually received treatment, he was billed for a $300 copay — a cost he said he did not have before. He is now working with the drug manufacturer Johnson & Johnson to try to reduce the price.
Carrie Dayal, a nurse, said she previously visited a Cox clinic in the Springfield suburb of Willard with her husband, who has Type 2 diabetes. The clinic was a five-minute drive from their home.
Now, she said, the transition has created both logistical and financial strain. Her insurance premium has increased by nearly $200 compared to last year.
“It’s just a financial strain,” she said. “Also the provider I’m seeing, I got their first appointment date in April. So we’re just having to wait and are kind of stuck in between if anybody is sick or has a problem.”
Rachel Swindle, a PhD candidate and policy researcher at Harvard University said disputes like this often come down to negotiating power between hospitals and insurers.
CoxHealth is a major player in the Springfield area, giving it significant leverage in contract negotiations.
“From the hospital's perspective, it sounds like they have a lot more negotiating power, as we've mentioned earlier, like, they have the largest market share in terms of the provider landscape in that area,” Swindle said. “That means that they have more power when you're negotiating those rates with insurers to extract a higher price from insurers.”
When those negotiations break down, she said, patients are often left to bear the consequences.
“There's probably blame to go around, both from the insurers, from the hospitals and big health systems but also from policymakers and federal regulators and their failure or slow response times contribute to a lot of these dynamics,” she said.
