Idaho is being rebellious. A couple of weeks ago stories began to surface that Idaho is looking at allowing health insurance plans to be sold that don’t fall within the strict rules of the Affordable Care Act.
By now you’re probably a bit lost in this. In response to Idaho Governor C.L. “Butch” Otter’s executive order the state considered alternative health plans, Blue Cross of Idaho — the top producer in Idaho’s ObamaCare exchange, or marketplaces as they’re called — has submitted five Blues Freedom plans.
The provisions of those plans violate the Affordable Care Act’s rules by not covering maternity care, not covering all pre-existing conditions and have a number of other issues.
While not big fans of ObamaCare, the Trump administration is going after Idaho to make sure this doesn’t happen. Maybe it would be more accurate to say not going to happen yet.
The administration sent a letter to Otter and state insurance commissioner Dean Cameron expressing concern and suggesting Idaho fall back in line. It came via Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma.
Otter and Cameron responded immediately. Idaho is not going to give in on this issue and did not take the CMS and Verma’s notice as negative. “Contrary to news media interpretations, the letter from CMS Administrator Verma was not a rejection of our approach to providing more affordable health insurance options for the people of Idaho,” the letter said.
In fact, the governor and the insurance commissioner said, “Her letter made it clear that Idaho’s efforts to pursue innovative alternatives hold great promise, and we believe that Idaho’s plan aligns with the State’s responsibility for 'substantially enforcing’ Obamacare. In fact, we consider the letter an invitation from CMS to continue discussing the specifics of what can and cannot be included in state-based plans.”
In the minds of Otter and Cameron this is just the beginning.
“We will consider all possible options and then continue discussions with CMS and HHS [Health and Human Services] on how best to achieve our shared goals of reducing the costs of coverage and stabilizing our health insurance market,” they wrote.
To make sure you’re not misled, Idaho is not allowing the sale of policies outside of the ObamaCare rules. Yet. To that point and to mollify critics, HHS Secretary Alex Azar said no action will be taken until Insurance Commissioner Dean Cameron approves the plans and allows insurers to sell them. “I just don’t believe in premature opinions on complex, important topics — serious, weighty matters. Let’s see where the state of Idaho ends up,” he told reporters.
In the meantime, the CMS letter from Verma gives Idaho 30-days to respond. If not, the CMS and HHS will “investigate further.”
Cameron strongly disagrees with the CMS and Democrats critical of actions the state is considering. “We strongly disagree that we are not substantially enforcing the law. We feel it would be hard-pressed for the administration or for CMS to argue those points in a court of law.”
He finds it odd Idaho is being targeted because the plans being considered carry stronger consumer protections than demanded by the Affordable Care Act. State law in Idaho says insurers that sell one plan that meets ObamaCare standards can also sell plans that do not.
Those plans can leave out maternity coverage, children’s vision and dental care. They can charge older members higher rates than ObamaCare allows. They can put separate caps for prescription drug coverage and do away with preexisting conditions for a year if the individual was uninsured for 63 days before the policy is issued.
Federal subsidies are not included for those plans.
For weeks Democrats in Congress — and everywhere else — want to know if Azar and Verma will enforce the law. Hint. Read into that statement the word “lawsuit” if the law isn’t enforced.
Others are concerned, too. Trish Riley is the executive director of the National Academy for State Policy. She says if Idaho gets away with this, other states will follow. It could be the tip of the spear,” she said.
Former Obama administration CMS administrator Andy Slavitt agrees with Riley. “What they are proposing seems quite clearly to be illegal. The reality is, Congress passed a law that entitles Americans to those protections,” he said.
Cameron and Idaho’s governor say the state is doing what needs to be done to make sure people can find insurance. Enrollment in the Affordable Care Act hasn’t gone all that well from the beginning. Idaho says the reason is because insurance is not affordable. Blue Cross points out that since the marketplace in Idaho opened in 2014 the numbers enrolled have dropped from 80,000 to 55,000 last year. Most of those still in the program are purchasing the bronze plan and not the vaunted silver plan.
Why? Blue Cross spokesman Peter Sorenson says that’s because that plan is unaffordable.
Cameron says the new Idaho plan doesn’t disrupt but compliments and stabilizes the market. Alternative coverage means more Idahoans will sign up. And he quotes prices. The Blue Cross Blue Freedom Standard plan for a family of four is $572 a month. That’s close to $400 less than the Blue Cross plan on the ACA marketplace.
All that said and we now find ourselves back to reality. Cameron and Otter met recently with Azar. Cameron said, “The Secretary was very clear he had taken an oath of office and he intends on following the law.”
The story is not done. Idaho will continue — we suspect — to push the envelope. Weekly Industry News will keep you posted.
Source links: The Washington Post — link 1, link 2, The Hill — link 1, link 2