Idaho To Offer Health Coverage That Doesn't Meet ACA Guidelines

Feb 22, 2018

Idaho is now allowing health insurance companies to sell plans that don't offer all of the elements required by the Affordable Care Act.
Credit Idaho Health Exchange

The State of Idaho is now allowing new health insurance plans to be sold in the state that don’t meet some of the guidelines mandated by the Affordable Care Act.

Proponents say the move will promote more affordable rates in the state.

Idaho Department of Insurance Director Dean Cameron says too many healthy people are canceling their insurance, because the premiums are just too high.

“And it’s just gotten worse to the point of where we believe the only people on the exchange are those that either have a subsidy or severe health conditions,” says Cameron.

Cameron says convincing more healthy people to purchase coverage will lower the cost for everyone, including those on the state’s health exchange that have Affordable Care Act coverage.

Cameron says these state- based plans will have to adhere to most of the ten essential health benefits mandated by ACA. He says the exclusions include pediatric dental and vision, some versions offering no maternity coverage, and in some cases, a one million dollar cap on coverage.

Cameron’s Washington counterpart, Insurance Commissioner Mike Kreidler feels the idea is a move backward. He says the out of pocket costs to those insured under the state-based plans will be extreme.

“It is one that you would have huge out of pocket expenses that you would be liable for in any given year. For a family of four were talking like 24 thousand a year. And even for an individual it’s 12 thousand dollars a year. People don’t have that type of money lying around if they have to dig down for it,” says Kreilder.

Kreidler worries that the move could set the stage for other states to abandon the ACA guidelines, and offer policies with even less coverage, all in the name of affordability.

While the law states that the Federal government would prohibit any polices that don’t meet the ACA guidelines, University of Idaho Law Professor Richard Seamon says he thinks it possible the feds, under the Trump administration, will allow such polices to exist.

“I think that is what Idaho is relying on here that the current administration, realizing that there’s a fair amount of antipathy to the Affordable Care Act, is going to look the other way. Maybe it may end up asking Idaho to apply for a waiver, which it anticipates granting,” says Seamon.

Mike Kreilder says if the administration decides to allow the non ACA compliant plans, it should expect push back from other states.

“But it certainly won’t stop states, then, in court form challenging this action by the administration,” says Kreidler.

Idaho Insurance director Dean Cameron feels they are meeting the intent of the law, and the new plans will strengthen the ACA plans by lowering the cost of all health insurance.

“We believe we are substantially enforcing the ACA. We are requiring ACA plans be made available, we believe we can legitimately argue and show how the state-based plans will ultimately help the ACA plans and compliment the ACA plans,” says Cameron.

The future of any non ACA based plans could certainly change with the arrival of a new federal administration.