Kansas, following Iowa, and with other Republican legislatures sure to follow, is attempting to do what federal Republicans have failed at: gut the Affordable Care Act. The state is trying to resurrect the kinds of crap insurance policies the ACA tried to eliminate—policies that exclude key benefits, aren't available to people with serious pre-existing conditions, and have coverage caps.
Of several proposals the legislature is considering, one is particularly dangerous. It would allow the Kansas Farm Bureau to sell "health benefits coverage" that would not be considered health insurance under the law. It has already passed in the state Senate, though the likelihood of a path through the House is unclear. The "coverage" would be available to the general public, not just members of the Farm Bureau and people employed in agriculture in general. The plans would act like insurance, with subscribers and provider networks and payments to physicians, but would be exempt from all of the regulations of the ACA and even be outside the purview of the state's department of insurance to regulate.
The legislature and the Farm Bureau are responding to a problem that's very real: The subsidy structure under the ACA makes coverage too expensive for many middle-income Americans, particularly in rural areas where there are few insurance options available. The pools are small in these relatively sparsely populated areas, and expensive for companies that have to comply with the ACA to compete in them. So they don't. That leaves room for these kind of noncompliant plans to step in, providing coverage that won't help a subscriber if she or a family member ends up getting really sick.
"I'm just amazed at how quickly we forget," Sandy Prager, the state's former insurance commissioner and a Republican, told HuffPost. "There were a lot of people out there left out of the markets because they had pre-existing conditions; they couldn't get comprehensive coverage for what they needed, and the only way to really solve the problem is to make the same rules apply to everybody." The Republican way, though, is to make sure the same rules don't apply to everybody, and if that leaves people out in the cold, bankrupted, and sick, so be it.
It's unclear at this point whether the bill will get through the House and whether the state's new Democratic Gov. Laura Kelly will sign it—she hasn't made a definitive statement. But what is clear is that the GOP legislature is intent on finding a solution to a very real problem that doesn't help the majority of its people. It could follow the path of seven other states, including Alaska, Minnesota, and Wisconsin, that have created reinsurance programs. That's a fund created to reimburse insurers that take on high-cost customers that drive up premiums. It helps attract insurers and allow them to make premiums more affordable. Medicaid expansion would help people at the other end of the spectrum who are in the gap between existing Medicaid and Obamacare.
There's also a short-term federal fix, if Mitch McConnell and Donald Trump would be willing to do it. Congress could restructure the subsidy system, providing premium assistance for people at more than 400 percent of the federal poverty level, where subsidies now cut off. That cut-off is at about $49,000 for an individual and just over $100,000 for a family of four.
The other answer, a longer-term one, is taking private insurers largely or entirely out of the picture with Medicare for all and guaranteed universal access. It's worked for most of the rest of the industrialized world. It would work for Kansas.