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Health insurance legislation could put Missouri ahead of the game


JEFFERSON CITY, Mo. — Missouri may be ahead of the game in terms of legislation filed to update the state’s health insurance laws. The bills — both sponsored by Rep. Justin Hill — are designed to get more Missourians insured and shore up the fiscal health of the individual market.

“Right now the number one issue on voter’s minds is health insurance,” said Hill. “It should be a priority for our state, it is certainly a priority for our constituents.”

The first bill Hill introduced — which has passed the House and is in the Senate — lengthens the time frame of short-term policies. Short-term policies are traditionally geared towards young, healthy individual and are less expensive.  

Short-term medical policies are under the purview, or jurisdiction, of the state. States have regulation and policy-making authority on health insurance that is less than a year-long contract. Affordable Care Act policies are exactly a year-long contract and short-term policies are anything less than one year.

Short-term policies were shortened from six months to three months through rulemaking during the Obama administration.

“That actually harmed people more because now people had to renew their policies every three months,” said Hill. “Those people that didn’t qualify for a subsidy or those that chose just not to participate in the Affordable Care Act because it wasn’t affordable, were forced to take these policies that would renew every three months. If they were to get a condition that would jeopardize their ability to go through underwriting in three months then they would be without coverage the rest of the year. It was a punitive way to push the mandate on people.”

Recently, President Donald Trump’s administration has indicated they would ease restrictions on short-term medical policies.

“I noticed that as the price of insurance went up more people went to other methods to insure themselves and the primary method being short-term medical policies,” said Hill. “The Obama administration shortened them. I want to lengthen them.”

His bill would move the state mandate attachment point to 12 months, rather than six months. This would enable people who elect to get coverage this way, underwritten and affordable, to do so without losing coverage in the middle of the year, according to Hill.

“We want people to have coverage all year long,” he said.

Rep. Justin Hill

Hill presented his idea at the National Conference of Insurance Legislators and CMS — the regulatory body of the Affordable Care Act — reached out to him to get more detailed on Hill’s idea. According to Hill, the following day the Deputy Administrator of Health and Human Services reached out to Idaho and shared what was essential Hill’s idea from the conference as a way to accomplish their goal without ignoring the mandates of the ACA.

Some states — including Idaho — tried to change their state offerings on their exchange, ignoring the mandates of the Affordable Care Act, according to Hill. Even the Trump administration said recently that states can’t do that, but short-term medical policies are an option for states to accomplish their goal.

“Number one, the short-term medical bill brings back underwriting. So, it is a way for people who don’t get subsidized to be able to afford insurance again. So the young and healthy folks that are not participating because it is too expensive. Those people will actually be able to have coverable,” said Hill. “Two, more coverage is better for everyone.”

The other bill Hill filed is a 1332 waiver, and that would give Missouri the ability to apply for a waiver from certain mandates of the Affordable Care Act, primarily in the financing of it. Three states have applied and obtained a waiver. So, if Missouri passes this, the state would be the fourth, likely, possibly the fifth.

“Basically that would allow us to use the advance-premium tax credit to shore up the fiscal health of the individual market,” said Hill. “So essentially what we are going to do is create a reinsurance for certain claims.”

If someone is not young and healthy, they have guaranteed insurance through the Affordable Care Act, which through the waiver would be more stabilized.

“The reason I filed both, is they are both needed,” said Hill. “We need to bring back underwriting to incentive young, healthy individuals to participate and we need to shore up the Affordable Care Act through reinsurance so that those who aren’t healthy can afford a policy that doesn’t have a really high deductible.”