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About the Series
This series is a product of Assessing the New Federalism, a multi-year project to monitor and assess the devolution of social programs from the federal to the state and local levels. Alan Weil is the project director, and Anna Kondratas is deputy director. The project analyzes changes in income support, social services, and health programs and their effects. In collaboration with Child Trends, Inc., the project studies child and family well-being.
There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The income support and social services Highlights look at basic income support programs, employment and training programs, child care, child support enforcement, and the last-resort safety net. The Highlights capture policies in place and planned in 1996 and early 1997.
Missouri has a robust economy and an advanced health care market compared to many other states. Its employment rate is notably higher than average and its poverty rate is lower than average, but its major health indicators are generally less favorable than those for the United States as a whole. In Missouri, managed care has significantly penetrated both the private and public markets. The state has developed an innovative children's health insurance program and has implemented one of the nation's first state-run health care purchasing coalitions for state and other public employees. Missouri's Medicaid spending per enrollee is quite low relative to that of most other states. However, the percentage of Medicaid spending dedicated to the state's disproportionate share hospital (DSH) program is one of the highest in the country.
State Characteristics
Sociodemographic Profile
In 1994-95, Missouri's population was 5.1 million (table 1). Roughly 72 percent of the state's population is concentrated in metropolitan areas, including St. Louis, Kansas City, and Jefferson City, the state's capital. Although the population in Missouri continues to grow, the rate of expansion slowed during the 1970s and 1980s. It picked up during the first half of this decade, expanding at an average annual rate of 0.8 percent.
Missouri's population is older than that of the United States overall. Children under age 18 comprise less of the population in Missouri than they do in the country as a whole (23.9 percent versus 26.8 percent), while individuals 65 and older make up slightly more of Missouri's population than the national average (13.9 percent compared with 12.1 percent) (table 1).
Missouri's population is less ethnically and racially diverse than the U.S. population as a whole. Non-Hispanic whites comprise 86.5 percent of Missouri's population, versus 72.6 percent nationwide. Only 1.8 percent of Missouri's population classify themselves as Hispanic, compared with 10.7 percent nationally. In addition, the state's percentages of non-Hispanic blacks (10.0 percent) and other non-Hispanic residents (1.7 percent), such as Asians and Native Americans, are slightly lower than the corresponding U.S. percentages (12.5 percent and 4.2 percent, respectively) (table 1).
Economic Indicators
The average per capita income for Missouri residents in 1996 was $23,022, about 6 percent below the U.S. average of $24,426 (table 1). However, there was a 4.9 percent increase in per capita income in Missouri from 1995 to 1996, slightly above the national increase of 4.6 percent. In 1997, Missouri's employment rate, at 67.9 percent, was higher than the national employment rate of 63.8 percent. In addition, 23,500 more state residents had jobs in May 1998 than did in May 1997.1
Missouri also is doing somewhat better than the national average with respect to the percentage of the population living in poverty. In 1994, 13.8 percent of Missouri's population had incomes below the federal poverty level (FPL), compared with 14.3 percent of the U.S. population. Further, 19.8 percent of children lived below the FPL in Missouri, compared with 21.7 percent of children nationwide.
Missouri's economy was primarily based on agriculture until World War II, when the state began to build up its service sector (particularly in St. Louis) and manufacturing sector, building aircraft and automobiles for the war effort. These industries continue to thrive; most notably, McDonnell Douglas (now a subsidiary of Boeing) is headquartered in St. Louis. In addition, U.S. automobile manufacturers, while headquartered in Detroit, have major facilities in the St. Louis area. Missouri is also an important manufacturer of food and chemical products.
Even today, however, Missouri is second only to Texas in its number of farms, which produce dairy products, beef cattle, and crops. The state also is known for its tourist attractions (it is the home state of Harry Truman and Mark Twain), outdoor recreation opportunities (the Ozark Mountains), and river commerce (the Mississippi and Missouri rivers join within its borders). St. Louis and Kansas City are major railway hubs.
Health Indicators
Missouri has not fared as well as the United States overall on a number of health status indicators, particularly those related to maternal and child health. Missouri's infant mortality rate, at 8.1 deaths per 1,000 live births, and percentage of low birth-weight births, at 7.6 percent, are both higher than the corresponding U.S. figures (7.2 deaths and 7.3 percent, respectively). The state's vaccination rate for infants ages 19 to 35 months is lower than the national average (74.0 percent compared with 77.0 percent for the United States) (table 1). Missouri fares better than the nation overall on indicators of violent crimes and reported AIDS cases. In 1996, Missouri had 590.9 violent criminal offenses per 100,000 population, compared with 634.1 nationwide, and the state had 16.0 reported AIDS cases per 100,000 population, while the country as a whole had 25.2 per 100,000.
The state's premature death rate (number of years of potential life lost before age 65 per 1,000 population) suggests that, on balance, the health of Missouri's population is about average (table 1). However, the state ranked 32nd on a composite measure of health indicators in 1997. This relatively low ranking was attributed in large part to the state's very high rates of heart disease and cancer.2
Politics and Budgetary Policy
Although political races in Missouri often are closely contested between Democratic and Republican candidates, the General Assembly, the governor's seat, and the state's delegation in the U.S. Congress are typically dominated by Democrats. Missouri's current governor, Democrat Mel Carnahan, was elected to his second four-year term in 1996. Missouri's state senate of 34 members consists of 17 Democrats, 16 Republicans, and 1 vacancy, and the house (163 members) has 86 Democrats, 76 Republicans, and 1 Independent.
State general fund revenues for fiscal year (FY) 1998 (including refunds) totaled $6.2 billion.3 Total state revenues, which include general-fund revenues, other state funds, and federal aid, were roughly $14 billion. General-fund revenue collections were up 5.7 percent from FY 1997, reflecting the strong economy.4
Spending from the general fund has also been increasing steadily. For example, from 1990 to 1995, the average annual growth rate of expenditures was 4.8 percent. General-fund spending on Medicaid as a proportion of total general-fund outlays declined during this period, from 7.1 percent in 1990 to 6.5 percent in 1995. In contrast, because of the large growth in DSH payments, total spending on Medicaid (including federal dollars) as a share of total state expenditures almost doubled between 1990 and 1995, from 11.2 percent to 21.8 percent. The state slightly increased the proportion of the general fund it spent on primary and secondary education between 1990 (41.5 percent) and 1995 (42.7 percent). Higher education's share declined from 12.7 percent to 10.6 percent, while corrections and Aid to Families with Dependent Children (AFDC) held steady (3.7 percent and 1.9 percent of spending, respectively).
More recently, spending increases from the state general fund have been budgeted for 1998 and 1999.5 In 1998, increases in spending total $295 million, including $79 million for criminal justice and $66 million for Medicaid. Of the total $376 million in spending increases authorized for 1999, $76 million is for criminal justice, $111 million is for Medicaid, and $46 million is for education.
Notes from this section
1. Missouri Department of Revenue Web site: http://www.dor.state.mo.us, 1998.
2. ReliaStar Financial Corporation. The ReliaStar State Health Rankings. Minneapolis, MN: ReliaStar, 1997.
3. Missouri Office of Administration, Budget and Planning Web site: http://www.oa.state.mo.us/bp/index.shtml, 1998.
4. Missouri Department of Revenue Web site: http://www.dor.state.mo.us, 1998.
5. Missouri Office of Administration, Budget and Planning Web site: http://www.oa.state.mo.us/bp/index.shtml, 1998.
Note: This report is available in its entirety in the Portable Document Format (PDF).
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