Missouri Senate passes bill exempting certain health insurance plans from federal protections

Yahoo

27-03-2025

State Sen. Kurtis Gregory shakes hands following his introduction to the Missouri Senate (Annelise Hanshaw/Missouri Independent).
The Missouri Farm Bureau would be allowed to sell health benefits plans that exclude people with pre-existing medical conditions and limit benefits to less than what's permitted by federal law for health insurers, under legislation that passed the state Senate Thursday.
Sponsored by Republican state Sen. Kurtis Gregory of Marshall, the bill would give the farm bureau a carveout to skirt the consumer protection requirements set by the Affordable Care Act, in an effort to provide affordable coverage options to members.
The bill was passed by the Senate by a vote of 24 to 6 on Thursday.
'This is not something where this organization is asking for government dollars to put this program into effect,' Gregory said during debate Tuesday. 'They want to put this on themselves. They want to help cover their members' lives.'
The Farm Bureau is a nonprofit agricultural membership organization which partners with for-profit companies to sell various kinds of insurance to its members. Anyone can join — the fee is $30 per year. Historically the group has been primarily made up of people in farming communities.
Missouri Democrats and patient advocates have staunchly opposed the proposal, raising concerns that consumers could be left with inadequate coverage and without proper protections.
'These insurance companies are for-profit companies,' state Sen. Tracy McCreery of Olivette said during Tuesday's debate. 'And I think that there needs to be some basic guardrails to make sure that there's some parameters that are consistent amongst providers.'
Ten other states have passed similar laws. This is the third year the proposal has been pursued in Missouri.
The bill characterizes the plans the Farm Bureau would offer as a 'health benefit plan' or 'contracts for health care benefits' rather than 'insurance,' to skirt state and federal regulations on insurance.
Democrats won some concessions, including requiring a written disclaimer in contracts that states the contract 'is not health insurance and is not subject to federal or state laws relating to health insurance.'
The disclaimer also states that the contract offers fewer benefits than a federally-compliant plan and may exclude coverage for preexisting conditions. It adds that the individual may qualify for federal insurance subsidies. Under the latest version of the bill, the state's Department of Commerce and Insurance must receive and review complaints from Farm Bureau members.
After hours of negotiation earlier this week, Senate Democrats finally allowed the bill to move forward, with several of their health-related priorities added as amendments as well.
Those additions include provisions that require Missouri Medicaid to cover hearing aids, which is also a freestanding bill passed by the House, expand access to treatment for sexually transmitted infections, and require insurance companies that provide birth control to provide extended supplies.
The bill now heads to the Missouri House, which has passed its own versions of the bill in recent years.
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Gregory has estimated around 15,000 Farm Bureau members lack health insurance and would be the target audience to enroll in the benefit plan.
Many farmers and other members of the Farm Bureau, proponents say, are uninsured because they can't afford to buy an individual plan on the Affordable Care Act marketplace or make too much money to qualify for subsidies.
Republican state Sen. Sandy Crawford of Buffalo, who sponsored the legislation in previous years, said she's heard from farmer constituents who can't afford health insurance for several years in support of the bill.
'It's hard for them to get coverage, and health insurance costs are through the roof,' Crawford said Tuesday.
'And I think anything that we can do to help…anytime we can give them one more tool for their tool box to at least help them get covered, I think that it's a good thing,' she said.
Several farmers and agricultural organizations testified in support of the legislation at the public hearing in January.
Missouri Farm Bureau lobbyist Emily LeRoy called the bill 'simply another option to provide coverage for more people.'
The Farm Bureau would offer lower prices by reverting to the pre-ACA practice of what's called medical underwriting, carefully evaluating applicants' medical history and risk, to determine whether to cover them and at what price.
Tennessee enacted a version of the law exempting the Farm Bureau from regulation in 1993
Benjamin Sanders, representing the Farm Bureau of Tennessee, said enrollees in states with the program report high levels of satisfaction. The Farm Bureau in other states doesn't need to abide by data transparency requirements of regulated insurance companies. But the organization says internal numbers show a high retention rate.
'We are not asking for any kind of subsidies or asking to sell subsidized plans. We manage cost on the front end,' he said, referring to the practice of medical underwriting.
Emily Kalmer, a lobbyist for the American Cancer Society Cancer Action Network, raised concern in January that the bill 'authorizes the sale of products that could discriminate against Missourians with pre-existing conditions like cancer.'
The bill 'would leave Missourians, including cancer patients, exposed to medical and financial harms,' Kalmer said.
Experts have said it could lead to insurance companies siphoning off healthy people and driving up the cost of coverage for others, while offering limited coverage plans.
Bill would exempt Missouri Farm Bureau health insurance plans from federal rules
Other insurance companies oppose the legislation for allowing just one group to be exempt from federal rules, which they say gives the Farm Bureau an advantage over its regulated competitors.
'I don't believe it should be the policy of the state to give a market advantage to companies selling unregulated products,'Hampton Williams, general counsel for the Missouri Insurance Coalition, said in January, 'over those who are offering existing health insurance products and who are have been lawfully operating within the state statutes and regulations.'
Shannon Cooper, lobbyist for Blue Cross Blue Shield, told lawmakers at a hearing in January that insurance companies would adopt similar policies to the bill en masse if allowed, to save costs, but federal and state regulations forbid that.
'It is a rare day when the insurance industry sides with the advocate community, but we all have the same concern here,' Cooper said. 'And that is: These products sound like insurance, but they don't follow the same rules that we have to play by. '
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