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Kansas health insurance

Single-digit rate increases for 2019, still three insurers in the exchange

Health insurance in Kansas

Kansas overview

When it comes to the Affordable Care Act, Kansas has maintained a stance of reluctance. The Sunflower State is among those that have not expanded Medicaid under the Affordable Care Act, and defaults to the federally-run health insurance exchange — albeit with a marketplace plan management model for the exchange (there are 28 states that rely on the federally-run exchange; six of them, including Kansas, use the marketplace plan management model).

The Kansas exchange has three insurers offering coverage, and one of them, — Ambetter/Sunflower — is expanding into two new counties for 2019. And although rate increases were substantial in 2017 and 2018, they’re much smaller for 2019.

During 2017 open enrollment, Kansas consumers who buy their own health plans through the state’s federally facilitated exchange saw larger percentage rate increases than the national average, with Blue Cross Blue Shield of Kansas Solutions raising average rates by 47.41 percent, and Blue Cross Blue Shield of Kansas City raising average rates by 28.1 percent. For 2018, Blue Cross Blue Shield of Kansas Solutions discontinued all of their plans (HMOs) and began offering EPOs under the name Blue Cross Blue Shield of Kansas. Since the plans were all new, there were technically no applicable rate increases. But Medica, which had joined the Kansas exchange statewide in 2017, raised their rates by an average of 29 percent in 2018. Ambetter/Sunflower (Centene) joined the individual market in two counties in the Kansas City area for 2018.

For 2019, the rate increases are much more muted: About 4 percent for Medica, 8 percent of Blue Cross Blue Shield of Kansas, and less than 3 percent for Ambetter/Sunflower. 88 percent of enrollees in the Kansas exchange are receiving premium subsidies, which offset all or most of the rate increase for those consumers, as long as they’re willing to shop around during open enrollment and potentially switch to a different plan (if necessary in order to get the best value).

Is the ACA helping in Kansas?

The Kaiser Family Foundation estimates that Kansas had 369,000 uninsured residents at the start of 2014.

According to US Census data, the uninsured rate in Kansas dropped from 12.3 percent in 2013 to 8.7 percent in 2016, and remained at that level in 2017.

As of early 2018, there were 77,258 people in Kansas who were receiving premium subsidies in the exchange to offset the cost of their individual market health insurance premiums. 40,043 of them are also receiving cost-sharing subsidies to reduce their out-of-pocket costs.

Because Kansas has not accepted federal funding to expand Medicaid, there are an estimated 48,000 people in the state who are ineligible for any sort of financial assistance with their health coverage, despite living in poverty. Expanding Medicaid would add significantly to overall ACA benefits for Kansas, but the state has not yet opted to do so.

2019 exchange rates and carriers

The individual market in Kansas has experienced some insurer exits and entrants in the last few years, as has been the case in most states. Following UnitedHealthcare’s exit from Kansas’ individual market at year-end, the state would have been down to a single exchange carrier for 2017. But Medica ended up joining the exchange for 2017 (Aetna/Coventry had also planned to join the Kansas exchange in 2017, but ultimately withdrew those plans).

For 2018, Blue KC left the individual market, but Ambetter/Centene/Sunflower joined in the Kansas City area (Johnson and Wyandotte counties). For 2019, Medica, Blue Cross Blue Shield of Kansas, and Ambetter/Centene/Sunflower are continuing to offer coverage. And Ambetter is expanding into two additional counties in the Kansas City area (Leavenworth and Miami).

The following average rate increases for Kansas exchange carriers have been approved for 2019:

  • Blue Cross Blue Shield of Kansas: 8.28 percent
  • Sunflower/Ambetter: 2.68 percent
  • Medica: 4.3 percent

The average benchmark plan (second-lowest-cost silver plan) available to Kansas exchange enrollees will be 6.8 percent more expensive in 2019 than it was in 2018, which means premium subsidies will grow to keep pace with the increase in benchmark plan rates.

Kansas enrollment in qualified health plans

In Kansas, 57,013 of an estimated eligible market of 298,000 people signed up for a qualified health plan through the state’s federal exchange during 2014 open enrollment. That figure equated to 19.1 percent of the eligible market. For comparison, No. 1 Vermont saw 85.2 percent of its eligible residents enroll; the national average was 28.0 percent.

2016 enrollment rates were almost double that of the initial ACA open enrollment period, with 101,555 people enrolled in private health plans through the Kansas exchange. Enrollment fell slightly in 2017, with 98,780 people enrolling in private plans through the exchange.

Each year, effectuated enrollment is lower than the total number of people who sign up, as some people never pay their initial premiums. So effectuated enrollment is a better reflection of how many people actually have coverage through the exchange. In early 2017, effectuated enrollment in the Kansas exchange stood at 86,310. By early 2018, effectuated enrollment was slightly higher, at 87,975.

Kansas and the Affordable Care Act

Kansas is a Republican-controlled state, with voters favoring Donald Trump by a wide margin in the 2016 election. Republicans hold the governor’s office and enjoy legislative majorities at the state and federal level. Unsurprisingly, the Affordable Care Act is not popular with politicians in Kansas.

In 2010, just one legislator among the state’s two senators and four representatives voted in favor of the Affordable Care Act. Kansas currently has only Republicans in both the U.S. House and the U.S. Senate, including Rep. Ron Estes, who won a special election in 2017 to fill Mike Pompeo’s seat, after Pompeo was tapped to head the CIA. The entire congressional delegation from Kansas is opposed to the ACA.

Kansas also joined the 2010 lawsuit challenging the constitutionality of the ACA (the Supreme Court ultimately upheld most of the law, but ruled that states could opt out of Medicaid expansion without losing the rest of their federal funding for Medicaid; Kansas has not expanded Medicaid).

Former Gov. Sam Brownback was a vocal critic of the ACA. He voted against the measure while serving as one of Kansas’s senators, and he continued his opposition after being elected governor. Brownback considered a state-run marketplace early on, but soon turned against the idea.

In August 2011, Brownback returned a federal loan earmarked for developing a state-run marketplace. Insurance Commissioner Sandy Praeger, also a Republican, argued hard for Kansas to operate its own exchange, but was unable to convince Brownback or state legislators.

Brownback was nominated by President Trump to become the US Ambassador-at-large for International Religious Freedom, so Lieutenant Governor Jeff Colyer assumed the governor’s office in January 2018. But Colyer lost the primary election in August 2018, so he’ll be replaced with a new governor starting in 2019.

Democrat Laura Kelly, a state senator from Topeaka, supports expanding Medicaid in Kansas, and has garnered endorsements from Republican former leaders in Kansas. The Republican candidate, Kris Kobach, is opposed to Medicaid expansion.

Kansas Medicaid

Medicaid expansion was one of primary mechanisms in the ACA aimed at reducing the uninsured rate. But Kansas is among the states that have not yet expanded Medicaid under the ACA. The state’s decision against Medicaid expansion leaves 48,000 Kansans in the coverage gap, meaning they neither qualify for Kansas Medicaid nor for tax subsidies to help purchase private coverage through the marketplace.

Governor Jeff Colyer, a Republican, has followed in his predecessor’s (Sam Brownback) footsteps in terms of strongly rejecting Medicaid expansion. But Colyer lost the Republican primary in 2018, so he’ll be replaced by a new governor in 2019. Heading up to the 2018 election, Democratic candidate Laura Kelly, who supports Medicaid expansion, has earned support from two former Kansas governors — both Republicans — and former US Senator Nancy Kassebaum, also a Republican. Lawmakers would have to approve expansion either way, but Kansas stands a better chance of expanding Medicaid if Kelly wins the election than if her Republican opponent, Kris Kobach, wins.

From late 2013 to July 2018, Medicaid/CHIP enrollment in Kansas has increased by just a 2 percent, although it had been up 4 percent as of early 2017. Nationwide, there has been a 28 percent increase, so Kansas is lagging well behind most states.

In Kansas, non-disabled adults without dependent children are not eligible for Medicaid regardless of income level. Adults with dependent children are eligible only if their household income is under 33 percent of the federal poverty level.

Medicaid is called KanCare in Kansas. See the Consumers section of the KanCare website for information on benefits, eligibility, and the application process.

Does Kansas have a high-risk pool?

Prior to 2014, when the ACA reformed the individual health insurance market, private coverage was medically underwritten in nearly every state, including Kansas. Applicants with pre-existing conditions often found themselves unable to purchase coverage, or only able to get policies that excluded their pre-existing conditions.

The Kansas Health Insurance Association (KHIA) was created in 1993 to provide a coverage option for applicants who were not eligible for plans in the private market because of medical history.

Because of the ACA’s guaranteed-issue provision, medical history is no longer a factor in eligibility for private plans in the individual market. This means that high-risk pools are not necessary the way they were prior to 2014. KHIA ceased operations on January 1, 2014, and was set to fully dissolved by June 30, 2015.  The program reported a successful termination following significant communication with members about transitioning to the private market.

Kansas Medicare enrollment

In August 2018 there were 520,736 Medicare beneficiaries in Kansas, which amounted to almost 18 percent of the state’s population — roughly the same as the percentage of the US population enrolled in Medicare.

Most Medicare enrollees in Kansas opt for Original Medicare, with just 17 percent selecting Medicare Advantage plans. That’s about half as high as the percentage of enrollees nationwide who select Medicare Advantage. When Medicare Advantage enrollment is lower than average, enrollment in stand-alone Medicare Part D (prescription drug) plans tends to be higher than average, since those plans are used in conjunction with Original Medicare. Nationwide, an average of about 42 percent of Medicare enrollees have stand-alone Part D plans, but in Kansas, 296,278 Medicare beneficiaries – about 57 percent of the state’s total – were enrolled in stand-alone prescription drug plans as of August 2018. There are 26 Part D plans available in Kansas for 2019, with premiums ranging from about $16 to $100 per month.

As of 2015, Medicare spending per enrollee amounted to $9,162 in Kansas for beneficiaries enrolled in Original Medicare.

You can read more about Medicare in Kansas in our state Medicare guide.

State-based legislation in Kansas

In April 2016, Kansas passed HB2454, legislation that allows health insurers to offer EPO plans with narrow networks and “gatekeeper” requirements similar to HMOs

Scroll to the bottom of this page to see a summary of what’s happening legislatively in Kansas with healthcare reform at the state level.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.