Senate adopts substitute for bill allowing membership "health contracts" for Farm Bureau model

The Missouri Senate on Monday adopted a substitute for Senate Bill 79 and perfected the measure, clearing the way for the proposal to be printed and advance through the legislative process.

Sponsor and supporters said the measure is intended to allow qualified membership organizations — the Missouri Farm Bureau was discussed repeatedly on the floor — to offer membership-based contracts for health-care benefits to their members. The substitute adds consumer-facing requirements, a complaint route to the Department of Commerce and Insurance and a 1 percent fee on claims paid to support oversight.

Senator from Saline, who explained the bill on the floor, said the measure is targeted at people he described as falling into a coverage gap: they earn too much to qualify for marketplace subsidies but not enough to qualify for Medicaid. "Eight percent of Missourians are going without health coverage right now," the senator said during his explanation, and the substitute is modeled in part on longstanding programs run by other state Farm Bureaus.

Why it matters

Senate Bill 79 would not create an insured product governed by the state—s insurance code; instead it defines a contract for health-care benefits that membership organizations may offer to members. Supporters said it offers a lower-cost option for some households that currently go without coverage and that the substitute includes transparency and consumer-protection language the sponsor said was negotiated after discussions with the Department of Commerce and Insurance.

What the bill says and what changed

- Consumer disclosure: The adopted substitute requires a front-page notice to anyone who signs a contract. The bill includes the following text as part of that disclosure: "This contract is not health insurance and is not subject to federal or state laws relating to health insurance. This contract may offer fewer benefits than an ACA-compliant health plan and may exclude coverage for preexisting conditions. You may qualify for income-based subsidies to the Affordable Care Act health insurance marketplace. This contract is not covered by the Missouri Insurance Guarantee Association." The text above is the verbatim disclosure read on the floor by the sponsor. (Transcript: Senator from Saline.)

- Protections for members in effect: The substitute includes the sponsor—s inserted language that "contracts provided under this section shall not be subject to individual post-claim medical underwriting while coverage remains in effect, and no member covered under a contract provided under this section shall be subject to cancellation, nonrenewal, modification, or increase in premium for reason of a medical event" while they remain enrolled and current on premiums.

- Complaint handling and fee: The substitute directs the Department of Commerce and Insurance (DCI) to receive and review complaints from members of a qualified membership organization and requires a fee equal to 1% of the previous year—s Missouri claims paid by the membership organization to be paid to the DCI to support oversight. (Transcript references: subsection 9 / section 374085 and section 374071 language; sponsor explanation.)

- Third-party administration, reinsurance and licensing: The substitute requires use of a regulated third-party administrator, adherence to state reinsurance law and that sales must be performed by life-and-health-licensed producers; qualified membership organizations must register with DCI to operate under the law.

Floor debate and amendments

Supporters pointed to other states— experience. The sponsor told colleagues the Tennessee model has operated for decades and that other states (Kansas, Arkansas, Nebraska, Iowa and several others) have adopted similar laws. He also offered statistical context from other models: Tennessee Farm Bureau processed millions of claims with only a small number of appeals (the sponsor read Tennessee figures into the record), and the sponsor said in Kansas 83% of enrollees had chosen the top-tier plan in that state—s program.

Several senators questioned details. The Senate—s registered nurse, the senator from the Seventh, offered an amendment to the amendment that would have required that policies authorized by the bill cover a list of 27 items that regular regulated insurance plans now cover in Missouri (including newborn screening and certain speech/hearing and mental-health benefits). The senator from the Seventh asked that the amendment-to-amendment be divided into 27 separate roll-call questions, a parliamentary motion that had enough members standing to trigger roll-call treatment. The transcript records the motion to divide the amendment into 27 questions and the request for roll call; the transcript does not record final roll-call outcomes on those 27 questions.

Final procedural actions

- The body adopted Senate substitute number 2 for Senate Bill 79 by voice vote (record: "the ayes appear to have it"). - The body then declared the substitute perfected and ordered it printed. Both procedural actions were approved by voice vote and recorded as "ayes have it" on the floor; no roll-call tallies were recorded in the transcript.

What the transcript does not show

The transcript does not record final roll-call results on the separate questions proposed by the senator from the Seventh (the motion to divide the amendment into 27 questions was made and five senators stood to request roll-call votes). The record also does not show final adoption of any of those 27 items in the amendment-to-the-amendment. The transcript stops short of any final passage of the underlying bill; it records adoption of the substitute and perfection/printing only.

Voices from the floor

- "This contract is not health insurance and is not subject to federal or state laws relating to health insurance," Senator from Saline read from the required front-page disclosure for contract applicants. (Senator from Saline, sponsor explanation.)

- "This amendment to the amendment contains a list of conditions that state law currently requires health insurance to cover," said the senator from the Seventh when offering the divided amendment and asking the body to vote on the 27 listed coverages. (Senator from the Seventh.)

Next steps

Senate substitute number 2 was ordered printed and will continue through the legislative process. The transcript leaves open several consumer-protection questions that senators asked on the floor, including whether certain statutory mandates should be extended to these contracts and how DCI will operationalize the complaint and review process under the substitute.

Votes at a glance

- Adoption of Senate Substitute number 2 for Senate Bill 79: voice vote, "ayes have it." (Outcome: adopted.) - Motion to declare the substitute perfected and ordered printed: voice vote, "ayes have it." (Outcome: perfected and ordered printed.)

Speakers quoted in this article appear in the on-record speaker list below. No names beyond the transcript references have been added. The article is based on floor remarks and the legislative text presented during the March 24, 2025 Senate session; it does not infer final bill language beyond what the adopted substitute and sponsor read into the record.

Ending

Senate Bill 79 now exists on the perfected, printed record as a Senate substitute and will proceed through the normal steps of the legislative calendar. Commitments made on the floor — including DCI complaint handling, the 1% oversight fee, and the front-page disclosure — will be questions for implementers and for any future conference negotiations if the measure changes in the House or in conference.