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Issue Position: Health Care - The Health Missouri Access Exchange

Issue Position

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Issue Position: Health Care - The Health Missouri Access Exchange

The Healthy Missouri Access Exchange - HealthMAX - is a new marketplace designed to increase access to care; provide Missourians with health plans that they, rather than their employer, own; and make coverage affordable for everyone.


The initiative to help Missourians purchase their own HSA plan could cover as many as 200,000 Missourians. HealthMAX as a whole will help many more obtain coverage. Although there are many differences between HealthMAX and a similar market created in Massachusetts, we can learn from the Massachusetts example. In late August, the Boston Globe reported that since the implementation of the new law, the number of uninsured in Massachusetts has dropped by 75 percent. Kenny Hulshof believes we can do better with HealthMAX. In Missouri, well over 500,000 Missourians could stand to gain access to affordable health insurance under the Hulshof plan.

Accessibility - Plans offered within HealthMAX may not discriminate based on health status, and access is open to every Missourian, whether they are unemployed, self-employed, or work for a small business or large corporation.

Portability - Since Missourians in HealthMAX own their own plans, they can take it with them when their job status changes. This also eliminates the hassle of COBRA premiums.

Choice - Today, most employees have limited options with their employer's health plan. With HealthMax, employees will have the option to choose from a variety of plans.

Voluntary - HealthMAX will be completely voluntary on the part of both participants and insurers. There will be no mandate that any individual purchase health insurance. Nor will insurers be prohibited from offering products outside of HealthMAX.

HSA Plans for Low-Income Missourians - To help Missourians who cannot afford insurance, HealthMAX will provide plans connected to health savings accounts (HSA). The state will pay the premiums for these plans and deposit funds into the accounts. Participants would be expected to share in the costs with up to five percent of their income. Every participant would have guaranteed access to $500 in yearly preventive medical services. If, at the end of a calendar year, a participant has used all of their preventive services and retains greater than $500 in their health savings account, they have an option: either roll the amount over $500 into their HSA for the next year or simply cash out the difference. This will encourage responsible management of individual accounts.

HSA Plans Available in HealthMAX - Unlike Medicaid, a system which most people would not buy into if they had a choice, the same plans that the state uses to help working low-income Missourians obtain coverage will also be available to everyone else in the state through HealthMAX. Putting these HSA plans into HealthMAX will guard against the risk of adverse selection.

Health Spending Debit Cards - Every Missourian who purchases an HSA plan with the state's help will be given a health spending debit card to use for their medical needs.

Tax Incentives for Individuals to Join HealthMAX - To help Missourians just outside the upper limit for direct state aid, Kenny Hulshof will create bold new tax incentives for the purchase of plans within HealthMAX. The precise incentive level would be based on previous insurance status and income. Those who have been without coverage for twelve months or greater could claim slightly higher incentives.


HealthMAX will help Missourians just outside Medicaid income limits obtain coverage through state-subsidized HSA plans. This will cost the state less than $50 million in general revenue. For those with slightly higher incomes, the state will provide tax incentives to purchase plans within HealthMAX. Tax incentives are forecasted to be in the range of $10 - $20 million.

These numbers are estimates subject to change as a result of updated information from the United States Census.


As governor, Kenny Hulshof will not take any action that would put our state on the path to insolvency. He will phase-in the HSAs over a period of five years, and pay for the remainder of HealthMAX with the following sources:

Cost-Sharing - Unlike a straight 1970s-style government welfare program, HSA plans within HealthMAX will require participants to pay a portion of the cost.

Missouri Foundations for Health - The Missouri Foundations for Health were created in a settlement to a lawsuit filed in 2000. The stated purpose was to help Missouri's uninsured. In all, the Missouri Foundations for Health have an estimated $1.8 billion in assets.

Unfortunately, not all funds are dedicated to the intended purpose - helping Missouri's uninsured population. While the Foundations have undoubtedly done some good work, they have also been used to reward political supporters - including abortionists. The Foundations are public bodies, but their members are political appointees with no oversight from the voting public. Kenny Hulshof will change this. He will ensure that the Foundations' public funds are appropriated without regard to politics.

Savings Within MoHealthNet - Experts agree that better efficiency controls in the management of MO HealthNet could trim three percent off its annual budget, which would save the state roughly $45 million per year in general revenue expenditures.

The HealthMAX Framework - Because it is merely a small administrative structure, HealthMAX itself will be relatively cheap to create. Companies like and Google will bid for the right to maintain the information in HealthMAX. After a small initial start-up cost, costs of maintenance will be paid through small administrative fees for participants.


Encouraging Greater Health Care Choice in Rural Missouri - As someone born and raised on a farm in southeast Missouri, Kenny Hulshof is intimately familiar with the challenges of gaining access to care in rural areas.

He will help address this problem by creating new initiatives to encourage doctors and nurses to provide health care services in areas of need. These initiatives would include tax incentives for the construction of new health care facilities and for health care professionals providing services in these areas. It would also include new scholarship and loan repayment programs for future and new health care providers. Finally, it would include efforts to extend telehealth practices and residency programs for young doctors to more rural settings.

Tax Benefits and Ease for Small Business Owners - Small businesses which name HealthMAX as their employer-sponsored health care plan make premium payments for their employees with pre-tax dollars. Instead of facing the difficult task of deciding which plan will work best for everyone in their business, the owner simply names HealthMAX as its provider, and continues to make the same contributions to their employees' health plans, saving time and resources for the employer.

Better Information for Missourians on Price and Quality - Our current health care system is price blind and quality-silent. Kenny Hulshof believes this has to change. He will work to establish policy that allows Missourians to compare prices and to obtain information about the quality of care from providers. The information would be published on an easily-searchable website so that Missourians can see just what they're getting, and at what cost.

Making Insurance Contracts Easier to Understand - All plans within HealthMAX will be required to conform to a uniform standard that will make it easy for Missourians to search for plans based on their own needs.

Creating a Stable Pool - Unlike other exchange-based reform plans, HealthMAX will not be limited to small employers. Immediately upon its creation, every state employee will have optional access to HealthMAX plans. Every county and municipal government in the state will also be encouraged to provide the same access to their employees.

Creating a Re-Insurance Based High-Risk Pool - To guard against the risk of adverse selection, we will create an "inclusive" high-risk pool based on sound re-insurance principles.

Electronic Health Records - Millions of Americans die every year because of inadequate and antiquated health records. Kenny Hulshof believes we should work to prevent every one of these tragedies. To help in that process, he would work with providers in urban, suburban, and rural areas to create a network allowing for better use of electronic health records.

Some hospitals have started to adopt electronic records. Unfortunately, because they work with different software, doctors often have a difficult time transferring the information. Worse, some providers in rural Missouri do not have access to electronic records at all. Kenny Hulshof will work on interoperability between providers who already have electronic records and access for those providers who do not currently have it.

Buying Insurance across State Lines - Kenny Hulshof supports plans to allow Americans to buy health insurance across state lines. As governor, Kenny Hulshof will direct the state Department of Insurance to seek out regulatory reciprocity agreements with other states. These agreements would allow Missourians to purchase insurance from the states with which we make agreements. It would also allow them to participate in association health plans with groups across state lines.

Initiatives to Help Missourians Kick the Smoking Habit - Smoking is another common risk to health and public budgets. Thanks to a previous settlement with tobacco companies, Missouri has access to a large sum of money for public health programs. Kenny Hulshof will use these tobacco settlements funds to help Missourians quit smoking - the intended use of these funds.

Education and Prevention Focus for Local Health Departments - "An ounce of prevention is worth a pound of cure," said Ben Franklin. Kenny Hulshof believes we can avoid many problems on the back end of our health care system by focusing on better education and prevention on the front end. To do that, he will focus local health departments on creating new programs with these twin goals in mind.

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