By Andy Marso
The Kansas City Star, February 21, 2019
Kansas Republicans and trade associations, empowered by changes President Donald Trump’s administration made to the Affordable Care Act, are pushing for health plans that are less expensive because they don’t have to cover pre-existing conditions.
One such bill, requested by the Kansas Farm Bureau, passed the Republican-controlled state Senate 28-11 Wednesday. It now heads to the House.
“According to a Gallup poll, citizens are more concerned about rising health premiums than pre-existing conditions,” said Sen. Mary Pilcher-Cook, a Republican from Shawnee who voted for the bill. “We should support lower cost of acquiring health care coverage, so people can have it before they develop what would otherwise be pre-existing conditions.”
Unlike plans under the ACA — commonly called Obamacare — alternatives like the Farm Bureau health plan could exclude people with pre-existing conditions. Such plans also wouldn’t have to cover things like maternity care, mental health and prescription drugs, which are required in ACA plans.
A number of measures have been introduced in Topeka to expand “association health plans,” which are offered to members of professional trade groups, many of whom are small business owners.
The most extreme example is the bill that would allow Kansas Farm Bureau to sell coverage that not only would circumvent ACA rules but also would not fall under the jurisdiction of the Kansas Insurance Department and therefore not be subject to any state rules either.
Kansas Farm Bureau CEO Terry Holdren told legislators that in a national survey, 65 percent of farmers and ranchers said the cost of health coverage was the top obstacle to being able to stay on a farm.
Several farmers testified for the bill, including Sarah Schmidt, whose family grows corn, wheat and soybeans across four counties near Junction City.
Schmidt said that before the ACA, she, her husband and their four kids paid about $525 a month in premiums for a plan that covered most local providers.
After the ACA their premiums doubled, and many of their providers were out-of-network.
“This has been one of our greatest struggles since coming back to my family’s fifth generation farm,” Schmidt said, “not only financially but also physically and emotionally.”
Association health plans have been available for some time, but the ACA required most of them to cover 10 “essential health benefits” (hospitals, outpatient physician visits, emergency services, maternal and neo-natal care, mental health and substance abuse treatment, prescription drugs, lab tests, federally recommended preventative care, pediatric care and rehabilitation).
Now they can get out of those federal requirements.
Lobbyists for Kansas health insurance companies have come out strongly against the Farm Bureau plan, saying it would be impossible for them to compete.
Kari Rinker, a spokeswoman for the MS Society, said that before the ACA, association plans had “a long history of fraud and insolvency which have historically harmed small employers and individuals the most.”
“Many of these plans collected premiums for health insurance coverage that did not exist and did not pay medical claims — leaving businesses, individuals, and providers with millions of dollars in unpaid bills,” Rinker said. “For people with chronic illnesses or disabilities such as MS, the results have been disastrous.”
Dana Bacon, a spokesman for the Leukemia and Lymphoma Society, said short-term plans often have fine print that allows the insurer to look back into a person’s medical history to find things that could justify denying claims.
Democrats and patient groups said that even if everyone knows the limitations of the coverage they’re buying, people with pre-existing conditions or people who need things like maternity care will still be harmed by something called “adverse selection.”
That’s when healthy people leave the ACA markets for things like association plans or short-term plans. The people left behind, for whom those plans aren’t a viable option, then end up paying higher premiums.
By Don McCanne, M.D.
It is easy to understand how a Kansas farmer and her family, living on a modest household budget, would have been upset with the Affordable Care Act that doubled the family’s insurance premium while taking away choices of their health care providers because of network limitations. Something needed to be done.
What is difficult to understand is why the Kansas state legislators responded with policies that would only make things worse. Coverage of essential health benefits is no longer guaranteed. Preexisting medical conditions can be excluded from coverage. As people leave the plans to enroll in junk insurance, premiums for those remaining will go up because those with greater needs will stay in the plan – classic adverse selection. The death spiral that results can cause insurers to leave the market, leaving residents with not much in the way of options, especially when the legislators refuse to expand the Medicaid program thus leaving the desperate, well, desperate.
What this cries out for is a national program of social insurance – include everyone in a national health program automatically and pay for it equitably. A Single Payer Improved Medicare for All would cover everyone and make it affordable for each, based on ability to pay. Although some states make the effort, no state has yet been able to include everyone equitably. Other states, such as Kansas, don’t even try, often leaving their residents high and dry. Anyone who needs health care should have health care, including the residents of Kansas. We can do it.
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