Missouri is in the majority. Most states have either refused to set up exchanges or haven't worked out any plans yet. But that doesn't mean uninsured residents of these states are out of luck. It just means that starting in 2014 they'll be shopping for health insurance in an exchange run by the federal government. All of the health insurance companies will be private, as they are now. The exchange will probably be on-line. But new rules will mean people who couldn't previously get health insurance should be able to.
"One of the best things about this is pre-existing conditions can not be part of the premiums. So, the only thing health insurance premiums can vary on are age, where you live, and smoking. These premiums will probably be on the order of $5,000 a year or less. for a year? per year. that's what the estimates are." said Washington University Health Policy Analyst Tim McBride.
But, there's one big problem. Health insurance for the very poorest people is supposed to be taken care of by the states expanding their Medicaid programs. Missouri has refused to do that. So that means several hundred thousand poor people in Missouri might end up with no health insurance coverage of any kind.