The Missouri Farm Bureau wants to offer members unregulated health plans and needs a state law to do so. The health plans would not be the same as health insurance — which must comply with the Affordable Care Act — and patient advocates say that’s cause for concern.
Missouri Farm Bureau President Garrett Hawkins said bureaus in 10 states currently offer health plans, and he wants to be number 11.
Hawkins said farmers’ incomes change from year to year, affecting their ability to qualify for subsidies on the health insurance marketplace.
“We have seen growing interest among Farm Bureau members who are seeking ways to address this tremendous risk in their lives,” he said.
In order to offer a health plan that does not comply with the federal Affordable Care Act — such as the one the Missouri Farm Bureau is proposing — companies need state lawmakers to approve. But Missouri patient advocates warn unregulated health plans can discriminate based on pre-existing conditions and are not subject to minimum coverage standards that include preventative care.
Emily Kalmer is the Missouri government relations director for the American Cancer Society’s Cancer Action Network and said the health plans don’t have to comply with consumer and patient protections established in Missouri law.
“This bill allows the sale of unregulated health plans, not legally insurance, and they would leave Missourians, including cancer patients, exposed to medical and financial harm,” Kalmer said.
Challenges to farmer health coverage
The Missouri Farm Bureau estimates nearly 8% of Missourians go without health coverage.
State Sen. Kurtis Gregory, R-Marshall, said the Missouri Farm Bureau could offer health plans to that population. Gregory is sponsoring the Senate Bill 79 that would allow for bureau health plans, and said farmers and ranchers often fall in the gap of those who don’t qualify for Medicaid but cannot obtain subsidies for health insurance on the marketplace.
“For some of our farm and ranch families, someone — instead of staying home working on the farm like they want to — has to have a job in town or some other form of getting health coverage,” he said.
Hawkins said lack of access to affordable health coverage compounds economic challenges for farmers.
“What's heartbreaking to me is that we have members who today can't afford health coverage and are going uninsured,” Hawkins said. “They are one catastrophic event or one medical emergency away from potentially losing the farm.”
The Missouri Farm Bureau health plans would only be available to the organization’s members and the bureau expects the plans to "cost 30% less than comparable unsubsidized plans" on the health insurance marketplace.
The company currently offers insurance policies for auto, farm, home, life and business. Hawkins said bureau health plans would provide options for rural counties that don’t have many health policy choices.
“The beauty of this is the fact that we are not creating something new,” he said, referring to bureaus in other states that offer health plans. “I don't plan to reinvent the wheel.”
Gregory’s bill is geared toward the Missouri Farm Bureau but would also allow for other qualifying organizations to offer health plans. Groups must have more than 100,000 dues-paying members and at least $500 million in assets.
Gregory has put the proposal forward numerous times and said last year it passed the Missouri House of Representatives. This year, it began the legislative process in the Senate and passed. It needs to pass the House and be signed by the governor to become law.
Risks of unregulated health coverage
Patient advocacy organizations in Missouri — such as the American Cancer Society and the American Lung Association — warn against the drawbacks to unregulated health plans and have testified in opposition to Gregory’s bill.
If the bill passes, the health plans offered by the Missouri Farm Bureau would not have to comply with the Affordable Care Act. Kalmer said that means they are less comprehensive than health insurance plans on the marketplace.
“We've seen ways that insurance companies have not covered important issues for cancer patients and cancer screening, and we've advocated to change those laws,” Kalmer said. “Now, these plans would be able to avoid all of those protections.”
Since the farm bureau health plans are unregulated in the states where they’re offered, Kalmer said there are limited records for how they fare. She said the health plans may look cheaper on the front end but could expose patients to unexpected costs.
Kalmer said Missouri Farm Bureau health plans could also have an impact on the health insurance marketplace.
“They can cherry pick younger, healthier individuals and when you remove those healthy people from the insurance pool … it can drive up premiums in that market,” Kalmer said.
Laura Turner is director of advocacy for Missouri with the American Lung Association, and said unregulated health plans leave Missourians with less recourse and consumer protections if they are denied coverage or dropped from their plan.
“If they were going to be regulated by the insurance commissioner, that would not be as much of an issue because they would have to follow the same rules that other insurance plans would follow,” Turner said.
Turner said the Missouri Farm Bureau is looking for a carve out from those regulations. She agrees barriers that are keeping Missourians from affordable health care should be addressed.
“Why not deal with those barriers rather than presenting a sub par product?” Turner said. “I want people to get health care coverage, but I want it to be quality coverage too. So, let's work together to make that possible.”
The legislation has passed the Missouri Senate and is scheduled for a hearing in the Missouri House of Representatives Health and Mental Health Committee at 4:30 p.m. Wednesday.
