TOPEKA, Kan. -- Republican lawmakers in Kansas pressed ahead Friday with allowing the state Farm Bureau to offer health coverage to members that doesn't satisfy the Affordable Care Act, a state-level effort to circumvent an Obama-era law that President Donald Trump wants to replace.
The Kansas House approved an insurance bill on an 84-39 vote that includes provisions to exempt health coverage offered by the Farm Bureau from state insurance regulation, anticipating that the nonprofit group could offer lower-cost products to thousands of individuals and families. The Senate approved the bill Thursday on a 28-12 vote, so it goes next to Democratic Gov. Laura Kelly.
The bill had overwhelming support from GOP legislators and faced strong opposition from Democrats, but Kelly hasn't taken a public position on it. The Kansas proposal is patterned after a Tennessee law in place for decades, and Iowa enacted a law last year.
The votes in Kansas demonstrated the Farm Bureau's political clout, particularly in rural areas, where Republicans dominate politics. The bill also had the support of most urban and suburban GOP lawmakers who continue to oppose the 2010 federal health care overhaul and argue that its mandates have driven up health insurance premiums and hurt the economy.
"It's just another option," said House Majority Leader Dan Hawkins, a conservative Wichita Republican and insurance agent.
Passing the bill was among the last significant actions Kansas legislators took before starting an annual spring break set to last until May 1. They put off a vote on a proposed $18 billion-plus budget for the state fiscal year beginning in July until after the break.
Some Democratic critics of the Farm Bureau bill tried unsuccessfully to block its passage by appealing to rural Republicans who support expanding the state's Medicaid health coverage for the needy in line with the Affordable Care Act. The House passed a modified version an expansion plan from Kelly last month, but the Senate has yet to take it up.
"There's more than one piece that's going to solve what we're facing," said Rep. Jason Probst, a Democrat from south-central Kansas. "We should hold this part of the puzzle up until they take action on their part of the puzzle."
Farm Bureau officials said they expect about 42,000 people eventually to take its coverage if the law passes, promising lower rates than plans complying with federal mandates. They believe the takers would be individuals who either have no coverage or struggle to pay for individual coverage.
Kansas has seen the number of individual coverage plans offered through the federal ACA marketplace decline to 23 for 2019 from 42 in 2016, according to the Kansas Insurance Department. While average rate increases for 2019 were smaller than in past years, they've sometimes previously topped 25 percent, according to annual reports from the department.
Republicans repeatedly have cited premium increases as a reason to repeal the ACA since Trump's election in 2016, but a drive in Congress to do it stalled when they couldn't agree on a replacement. Trump this week deferred another push until after the 2020 election.
The Farm Bureau's new coverage would avoid state regulation because the new Kansas law simply would declare that it's not insurance.
Critics said companies offering traditional health insurance coverage would face unfair competition. They also focused on how Farm Bureau would be able to set higher rates or reject coverage for people who have pre-existing medical conditions, something the Iowa law allows.
To drive home their argument that legislators don't know yet what a Farm Bureau plan might cover, critics said the lack of regulation would allow it to pay for elective abortions. A 2011 state law prohibits such coverage in group health plans, requiring people to buy separate abortion policies.
Supporters of the bill — many of whom strongly oppose abortion — brushed aside the criticism as desperate.
Farm Bureau officials have said they pushed for permission to offer health coverage because members are asking for more choices.
"They are clamoring for some kind of solution," said Rep. Don Hineman, a moderate Republican from western Kansas who also supports Medicaid expansion. "The potential consumers for this product are begging us to do it."
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