Missouri could become 14th state to offer alternative health plans for farmers

It's hard for Megan Richner to know what her health care will look like in a year.

"Every year we go back to the drawing board to figure out a policy or a plan that would be right for our family," Richner said.

That's largely an occupational hazard. Richner and her husband raise cattle in El Dorado Springs, Missouri, about 75 miles northwest of Springfield. She also teaches middle school science, but said adding her husband and son to her employer-sponsored health insurance plan is cost-prohibitive. Because farm income fluctuates, it's hard for her to buy private insurance.

"If you are self-employed or if you're in the business of farming and ranching, your income is not predictable," she said.

Richner's frustrations with the inaccessibility and unaffordability of the health care marketplace insurance policies led her to testify in favor of a bill that would allow the Missouri Farm Bureau to offer health plans.

The legislation has passed both chambers of the Missouri legislature and is awaiting Gov. Mike Kehoe's signature or veto.

Afton Graham via Megan Richner

A Missouri Farm Bureau member since college, Megan Richner knows there's no guarantee the company's health plan will be cheaper or a better fit for her family. Nonetheless, she's eager for the option.

Farm Bureau health plans would not technically be insurance and therefore aren't subject to federal Affordable Care Act regulations or minimum care guidelines — such as emergency services and maternity and newborn care. The unregulated nature of the Farm Bureau health plans is why the organization needs permission from the state legislature and governor to offer them.

"This type of plan doesn't have to follow many of the things that people expect from health insurance, and we don't want a Missourian to purchase this and expect it to provide the care that they would need," said Emily Kalmer, the Missouri government relations director for the American Cancer Society's Cancer Action Network.

Kalmer testified in opposition to the bill. She's concerned unregulated health plans could include hidden costs — and that higher prices would deter Missourians from seeking preventative health care such as cancer screenings.

"These plans don't include patient protections that we fought for over the years," Kalmer said. "They can impose caps on your coverage. They can refuse to cover certain medical expenses that regular insurance plans can't. They can impose waiting periods on coverage, and they can decline to cover someone with a preexisting condition like cancer."

Missouri could join the more than a dozen other state farm bureaus that offer such health plans. Farm Bureau President Garrett Hawkins argues it's necessary because farmers "who make just enough to not qualify for a subsidized plan on the marketplace but yet don't have stable enough income or enough income to be able to afford these really high premiums" often fall through health care gaps, he said.

In a national ranking of state access and affordability to health care compiled by the Commonwealth Fund, Missouri is 35th. The state was late to expand Medicaid, an option made possible by the ACA, and it only did so after voters passed a ballot measure.

According to KFF, a nonprofit health policy research organization, more than 330,000 Missourians who use marketplace plans have their costs reduced by subsidies — an average of $595 per month. Health care industry experts anticipate marketplace policies will soon get more expensive as additional COVID-19 pandemic-era subsidies expire.

The Missouri Farm Bureau, along with being an agriculture advocacy and membership organization — is already an insurance company, offering auto, farm, home, life and business policies.

Since the Farm Bureau is waiting for the governor's signature before setting up the health plans, Hawkins couldn't estimate the cost of health coverage.

"What I can say confidently in the other states, is that (farm bureau) health plans, on average, are 30% less than an unsubsidized plan on the ACA marketplace," Hawkins said.

This spring, state legislatures in Florida, Alabama and Ohio also approved non-ACA compliant farm bureau health plans.

"We share the goal of ensuring access to health insurance and health care for farmers and everybody here in Missouri," Kalmer said. "We just don't believe these plans provide that."

Understanding what is covered

Farming can be a physically strenuous and at times a dangerous occupation — which heightens the risk of going uninsured.

"It just takes one diagnosis of cancer, one stroke, one accident, if someone does not have good health insurance coverage to really result in a financial disaster," said Sarah Bowman, a clinical instructor at Missouri State University who teaches a course on health insurance.

Photo courtesy of Megan Richner

Megan Richner and her husband raise cattle in El Dorado Springs, Missouri, about 75 miles northwest of Springfield. Because farm income fluctuates, it's hard for her to buy private insurance.

Bowman said there is often a disconnect between patients, health care providers and insurers.

"Many people assume that if their provider recommends a health service — such as a test or a procedure — then it will be covered by insurance. But really, there's no truth to that. The terms of each plan are spelled out before a person enrolls," she said.

Adjustments were made to the bill as it moved through the Missouri legislature, specifically addressing consumer education.

"There is a robust disclaimer on the front of our contract, so that members truly understand it is not insurance, that it's not regulated, but they are entering into a contract for health coverage with us," Hawkins said. "There was a desire to make sure that people are making as informed a decision as possible."

Another provision added to the bill was a requirement that a person be a Missouri Farm Bureau member for 30 days before purchasing a health plan.

At this point, Bowman said the legislation could certainly achieve one of the bureau's goals: expanding health coverage in Missouri — but the details aren't clear.

"It's just very vague. It doesn't say what's covered, what's not, and then what people will be paying for these plans," she said about the bill.

The ongoing challenge for private insurers, the federal government, and now the Farm Bureau, remains to find a way to provide health insurance affordably.

"We need people to be creative and think of new ways to pay for our health care, because we have the most expensive health care of any country in the world, and we don't even have the healthiest people, and it's just going to get more and more expensive as we age," Bowman said.

Farmer Megan Richner is willing to take the risk. A Farm Bureau member since college, she knows there's no guarantee the company's health plan will be cheaper or a better fit. Nonetheless, she's eager for the option.

"I sent a message to one of the staff at Farm Bureau and asked, 'how soon could we start looking into this if it passed?'" Richner said.

If approved by the governor, Missouri Farm Bureau health plans are expected to be available for members sometime next year.