The Obamacare health insurance market in Idaho is likely to have lower premiums as a result of the Trump administration's March 8 action indicating it would stop the state from selling coverage that doesn't comply with the health law. But many people who make too much money to get premium subsidies could continue to be left without affordable options.
The letter from Centers for Medicare & Medicaid Services Administrator Seema Verma provided a roadmap for what Idaho could do to sell noncompliant plans legally: resort to short-term health plans, which the administration has proposed enhancing.
Idaho Gov. C.L. “Butch” Otter responded that “we consider the letter an invitation from CMS to continue discussing the specifics of what can and cannot be included in state-based plans.”
The main setback for Idaho is that it apparently will not be able to include costs for noncompliant plans in the same market as compliant plans when premium rates are set. The state had wanted to make the state-based plans part of a so-called single risk pool along with ACA-compliant plans.
“The noncompliant plans would pull healthy risk out of the individual market, ultimately raising premiums for those in the ACA individual market,” Georgetown University adjunct professor Katie Keith told me. Keith applauded the federal action.
But most people in ACA exchange plans get premium subsidies anyway, so they wouldn’t see the higher premiums, Joe Antos, a health-care expert with the American Enterprise Institute, told me.
Idaho, which operates its own ACA exchange, is a prime example of what has happened since the ACA’s primary individual health insurance requirements took effect in 2014 in many rural states, where farmers and small business people often don’t have employer-sponsored coverage, Antos said.
“Since the advent of the Exchange in 2014, premium prices on the Exchange have increased more than 70 percent, nearly 30 percent last year alone, and all options on the Exchange are well more than $1,000 per month,” Blue Cross of Idaho said in a letter to Department of Health and Human Services Secretary Alex Azar. Blue Cross of Idaho had proposed selling the non-Obamacare compliant plans.
The number of people covered in the individual market in the state has decreased since 2014, and the number of uninsured people increased by 66,000 from 2015 to 2016, with about 250,000 people currently with no health insurance, Blue Cross of Idaho said.
Carriers have lost “massive amounts of money in the individual market since 2014,” a total of $294 million, the letter said.
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