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A Mission to Improve Health: The Story of Missouri’s Expanding Coverage Initiative

by Anna Saltzman; Katherine Lee; Shayla Spilker

Dec 1, 2019

The Expanding Coverage Initiative (ECI), a five-year investment of Missouri Foundation for Health (Foundation), aimed to dramatically increase enrollment in health insurance by supporting the implementation of the Affordable Care Act (ACA). The initiative's goal was to lower the state's uninsured rate from 13 percent in 2013 to five percent by employing three complementary strategies: (1) Creating awareness of the Missouri Health Insurance Marketplace and subsidies established through the ACA, (2) Assisting with enrollment of individuals, families, and small businesses in health plans through the Marketplace and Missouri's Medicaid program, and (3) Increasing health insurance literacy to help consumers understand how to make an informed choice of health plan and use it once enrolled.

The Foundation sought to build and coordinate a broad-based coalition—the Cover Missouri Coalition—and provide a supportive infrastructure, including a team of technical and content experts. Its plan was to muster the collaborative capacity needed to reach individuals across the state who were most likely to be uninsured, including people of color and individuals who were low-income or unemployed. As they planned the ECI, Foundation staff anticipated that by the end of the five-year endeavor, enrollment needs under the ACA would stabilize as the law became the new normal. However, history took unexpected turns, giving rise to substantial barriers to enrolling people in health insurance coverage.

A Mission to Improve Health: The Story of Missouri's Expanding Coverage Initiative takes a retrospective look at the ECI, which ended in 2018. This report offers lessons to inform future work of Missouri Foundation for Health, as well as Cover Missouri Coalition partners, other funders, and those working to advance broader health care access.