In June 2021, Texas enacted House Bill 3924. The legislation, which took effect in September 2021, allows Texas Farm Bureau to sell medically underwritten health plans that will not be considered health insurance. This means that the plans are exempt from state and federal health insurance regulations. The Texas Farm Bureau made these plans available as of mid-2022. Since the plans are not subject to insurance rules, they are not required to cover essential health benefits, cap out-of-pocket costs, or provide guaranteed-issue coverage. H.B.3924 specifies that the plans cannot exclude a pre-existing condition for more than six months after a person enrolls. But the plans are allowed to charge applicants higher premiums based on their medical history, or reject the application altogether. People who aren’t eligible to enroll in the Farm Bureau plans due to their medical history will still be able to sign up for ACA-compliant health insurance (through the Texas exchange or directly through an insurance company) during open enrollment or a special enrollment period. But consumer advocates worry that if healthy enrollees shift over to the Farm Bureau plans, they will leave the ACA-compliant risk pool with less healthy membership and thus higher premiums for everyone. It’s worth noting, however, that the American Rescue Plan’s temporary elimination of the “subsidy cliff” means that most people are now eligible for premium subsidies in the exchange, at least through the end of 2022 (and Congress might extend that provision with the Inflation Reduction Act, which would continue to eliminate the subsidy cliff through 2025). There are no subsidies available for Farm Bureau plans, so they’re really only an attractive alternative for healthy people who would otherwise have to pay full price for an ACA-compliant plan. And since more people are now eligible for premium subsidies in the exchange, there are fewer people who are likely to enroll in Farm Bureau plans instead. Indiana, Iowa, Kansas, South Dakota, and Tennessee have similar laws on their books, allowing medically underwritten, non-insurance, Farm Bureau plans to be sold (Nebraska also has Farm Bureau health plans available, but they can only be purchased by people actively involved in agriculture, and they do not use medical underwriting).