Health and Wealth

We’ve been hearing a lot about the Affordable Care Act from a number of politicians - Governor Jay Nixon, Senator Roy Blunt, and, of course, President Obama, to name a few.  These people can talk about the number of people insured and weigh the cost versus economic impact. But behind those numbers they’re citing are people, Missourians. Those dollar figures they throw around, that’s money in and out of our pockets. So how do Missourians who have been trying to utilize the new healthcare law feel about it? 

With the March 31 enrollment deadline for health insurance under the Affordable Care Act drawing near, healthcare centers across the state have been ramping up efforts to get Missourians signed-up. The group Cover Missouri organized a number of enrollment events across the state earlier this month.

On a Thursday morning in late February, a group of 100 middle and high school students gathered in the rotunda of the state capitol building in Jefferson City for a capitol day event organized by the Tobacco Free Missouri Youth Advisory Board. Their goal was to speak with their legislators about making the building smoke-free. Unlike every other public building in Jefferson City, the capitol building doesn’t entirely comply with the city’s smoking ban - lawmakers are unofficially allowed to smoke in their offices.

“They absolutely have the right to smoke and we’re not telling anyone they don’t,” said Youth Advisory board member Alex Higginbotham, age 17. “They can still smoke in their home, but we’re asking them in public not to affect us.”

According to the Centers for Disease Control and Prevention, Missouri is ranked 48th in the nation for number of adult smokers - roughly 1 in 4 Missourians over the age of 18 smoke. And the state ranks 50th for workplace exposure to second-hand smoke.  The state’s Clean Indoor Air law gives business owners the option to declare a public space smoke-free, or to set up a designated smoking area. If communities want to be truly smoke-free, it’s up to local governments to make that happen. In the fall of 2010, Jefferson City banned indoor smoking in public spaces, including the capitol building. But state legislators continue to not-so-secretly smoke in their offices.

Some of Missouri’s strongest anti-tobacco advocates just happen to be under 18 years old. More than one hundred students from across the state arrived in Jefferson City Thursday for an anti-tobacco advocacy and education event at the capitol organized by the Tobacco Free Missouri Youth Advisory Board. The students delivered over two thousand signatures of support along with pinwheels to represent their desire for clean air to House of Representatives Majority Leader John Diehl. Currently, Jefferson City and most of the capitol building are smoke-free, but legislators are allowed to continue smoking in their offices.

You’ve probably heard it before: rates of smoking and tobacco use in Missouri are some of the highest in the nation. Roughly 1 in 4 Missourians over the age of 18 smoke tobacco and the state ranks 50th for workplace exposure to second-hand smoke.  But what isn’t clear is why Missouri has consistently ranked so low compared with other states. I spoke with Traci Kennedy, Executive Director of Tobacco Free Missouri, who says it’s because lawmakers have made it particularly easy to be a tobacco user in the state.

The Affordable Care Act’s online health insurance marketplace has been open for business since October 1 and technical issues that plagued the website early on have mostly been resolved. Yet Missouri residents have been slow to sign-up for health insurance under the new law. According to the nonprofit group Kaiser Family Foundation, only 40 percent of Missourians eligible to enroll have actually chosen a plan. I spoke with U.S. Secretary of Agriculture Tom Vilsack about why signing up is important for Missouri residents, particularly in rural areas.  

Some of Missouri’s strongest anti-tobacco advocates just happen to be under 18 years old. More than one hundred students from across the state arrived in Jefferson City Thursday for an anti-tobacco advocacy and education event at the capitol organized by the Tobacco Free Missouri Youth Advocacy Board. The students delivered over two thousand signatures of support along with pinwheels to represent their desire for clean air to House of Representatives Majority Leader John Diehl.

On an afternoon in early December, 60-year-old Columbia resident Jeannie Wyble sits in a small cubicle at Columbia’s Family Health Center, telling Aaron Swaney, a HealthCare.gov application counselor, about the heart attack she suffered in 2002.

“I quit smoking when I had my heart attack,” Wyble said. “Smoked my last cigarette on the way to the ER, never smoked another one.”

At the time, Wyble was still insured through her husband’s union plan. But after the heart attack, the insurance company began increasing her monthly premium. Wyble says at one point, she had to pay almost $500 a month.

“And then when we found out they were going to jump even more again the following January,” Wyble said. “It was very clear to us that we couldn’t pay my premiums anymore and that mine would just have to be dropped. In effect, [the insurance company] decided to get rid of me, and it worked. They did. They got rid of me.”

The students at Gratz-Brown Elementary School in Moberly get excited every Tuesday and Thursday when the final school bell rings. This is not because school is over for the day, but because Running Club is about to start. The Running Club was started by Principal Della Bell and is in its second year. 

At only 17 cents per cigarette pack, Missouri has the lowest tax for tobacco in the U.S. In 2012, Missouri voters said no to increasing that tax to 90 cents per pack. Missouri is also one of 14 states that don't have some sort of a statewide ban on smoking in non-hospitality workplaces, and/or restaurants, and/or bars. All of this adds up to the Show-Me State's top spot as the freest state in the nation when it comes to tobacco. 

But since 2007, about two dozen municipalities in Missouri have enacted a comprehensive smoking ban in all workplaces, including restaurants and bars. This Monday, rural Washington, Mo., joins that list. The City Council voted to pass the ordinance to ban smoking back in January. 

The uphill congressional battle to expand Medicaid in Missouri is making rural hospitals that serve areas with high poverty levels really, really nervous. KSMU's Jennifer Davidson has the story.