Lawmakers approve bill exempting Missouri Farm Bureau health plans from federal rules

The wide-ranging bill includes provisions related to hearing aids, birth control and prenatal testing for sexually transmitted diseases

BY: CLARA BATES

Missouri Independent

Missouri Farm Bureau will be allowed to sell health care plans to its members, Medicaid will cover the cost of hearing aids for adults and supplies of birth control will be extended under legislation that passed the legislature in the waning hours of the session on Thursday.

The legislation, which was sponsored by Republican state Sen. Kurtis Gregory of Marshall, now heads to the governor's desk.

The underlying bill allows the Missouri Farm Bureau to sell health care plans that don't abide by the protections set by the Affordable Care Act. As a result, the Farm Bureau would be able to offer lower-price coverage options, which the organization and its supporters say is necessary to help uninsured farmers.

"This is a product that is going to get people coverage that otherwise cannot afford it," Gregory said at a House hearing last month. "This is a coverage product that is going to save lives. It is a product that's going to save people money."

State Rep. Brad Pollitt, a Republican from Sedalia who carried the bill in the House, said Thursday that the Farm Bureau's health plans "will not be the solution for everyone. But those without health care plans believe this will be beneficial."

This was the third year the bill has been proposed, and it's received significant pushback from Democrats and patient advocates, who argue it would leave some Missourians without protections. It's also faced opposition from insurance companies who argue it gives the Farm Bureau an unfair advantage over competitors.

If the bill is signed into law, Missouri will join 10 states that have adopted similar carveouts for the Farm Bureau in previous years. Alabama and Florida also passed similar measures this year.

Democrats added some protections to the Farm Bureau portion of the bill during negotiations, including mandating the organization to provide a clear disclaimer that the products it's selling are not officially regulated as health insurance, mandating the company can't cancel coverage for members because of a medical event and ensuring the state insurance department will handle complaints.

The bill contains a wide swath of other health measures, including several added by Democrats during negotiations, especially by state Sen. Patty Lewis of Kansas City.

Those include: provisions mandating that Missouri Medicaid cover hearing aids and cochlear implants for adults, expanding access to testing and treatment for sexually transmitted infections, requiring insurance companies that provide birth control medication to provide extended supplies and tweaking the law around telehealth to allow audio-only visits.

There was little opposition voiced on Thursday.

State Rep. Betsy Fogle, a Democrat from Springfield, said the negotiations "were able to make a bill significantly better with wins for the majority party, wins for the minority party and ultimately wins for our constituents back home."

The bill passed by a vote of 147 to 1 on Thursday afternoon in the House. That followed a vote of 24 to 6 in the Senate.

'This is a big deal'

The Farm Bureau would offer lower prices by reverting to the pre-Affordable Care Act practice of what's called medical underwriting — carefully evaluating applicants' medical history and risk — to determine whether to cover them and at what price.

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.

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.

Garrett Hawkins, president of Missouri Farm Bureau, said in an interview with The Independent shortly after the bill passed that the organization's effort has been years in the making.

Lack of health insurance options for farmers is "an impediment to bringing the kids home to the farm. It's an impediment to bringing a spouse home to the farm who has pursued off-farm employment solely to get health coverage," he said. "This is a big deal."

Emily Kalmer, a lobbyist for the American Cancer Society Cancer Action Network, said at a House hearing last month that even with concessions made at the urging of the bill's critics, patient advocates remain highly concerned.

"To be clear, this legislation still allows the Farm Bureau to sell unregulated products that won't have to comply with many of the other provisions we fought for over the years," Kalmer said, including protections for preexisting conditions.

Hearing aids and birth control

Medicaid coverage for hearing aids and cochlear implants for adults would be expanded under the bill passed Thursday. Currently, Medicaid in Missouri, which is called MO HealthNet, only covers hearing aids for eligible children, pregnant women and blind people.

There was little opposition to that change this year, but in prior years there has been some concern around the cost. The Medicaid hearing aid and cochlear implant provisions are estimated to cost up to $10.3 million in fiscal year 2027, and $2.7 million the following year, according to the fiscal note.

"I realize there are some costs to this," said state Rep. Cameron Parker, a Republican from Campbell. "But I do believe that the benefit of these services, the hearing instruments, the cochlear implants, outweigh the cost greatly."

The bill also requires health plans to cover extended supplies of birth control. Plans that provide coverage for hormonal contraceptives would be required to cover a supply lasting up to 90 days, or, for generic medication, up to 180 days — meaning patients would be able to pick up months-long supplies of the birth control pill at one time rather than needing to pick up the prescription more frequently.

The Independent's Jason Hancock contributed reporting.