The Trump administration gave no obvious “stop” or “go ahead” message to Idaho officials last weekend in regard to the state’s controversial latest move in health insurance.
Idaho’s governor and chief insurance regulator met with top federal health care authorities, hoping to make their case for why Idaho health insurers should be allowed to sell plans that don’t comply with the Affordable Care Act.
Gov. Butch Otter issued an executive order in January that rolled out a carpet for such plans. Idaho’s largest health insurer, Blue Cross of Idaho, jumped at the chance to start selling non-compliant plans and drew up five versions of plans that are now under state review.
The meeting Saturday was “a good opportunity” to tell Trump administration officials how prices have climbed for ACA-compliant insurance plans and that “people [are] being forced out of coverage,” Dean Cameron, director of the Idaho Department of Insurance, said Monday.
U.S. Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma were both present, Cameron said.
“I think Secretary Azar was sympathetic to the problems we are facing,” Cameron said. “We talked about how the market is bifurcated, and that the existing market was headed for collapse unless we were able to find some way to attract the young and healthy back into the marketplace.”
The controversial approach would allow insurers to do a few things the ACA forbids: use a person’s health status to determine how much they have to pay for insurance; deny coverage for pre-existing conditions in some cases; and set annual limits on coverage. Insurers also could require patients to foot a much larger share of their total medical costs than they would have to under ACA plans.
Those rules would allow insurers to sell plans with lower premiums to healthy, young people — although those customers would be at risk of much higher medical bills in the event of a major injury or illness.
While done through executive order, the move has the support of some lawmakers. A bill essentially replicating Otter’s order reached the House Health and Welfare Committee. But it died there Monday on an 8-4 vote after lawmakers said it raised too many questions too quickly, the Associated Press reported.
Cameron said he and Otter explained their rationale for the plans — which some legal scholars and health care policy experts consider blatantly illegal.
They also gave Azar a copy of a legal analysis drafted by lawyers for Blue Cross of Idaho. Cameron said Idaho didn’t help pay for the analysis, to his knowledge, but that Blue Cross’s lawyers were expected “to look at the legal analysis for the [state] as well as [Blue Cross].”
The company agreed to share its analysis with the Department of Insurance and Otter’s office. Cameron said he could not share it with the Statesman, as he believed it fell under privileged communication with an attorney.
“There were multiple meetings with legal counsel, including the [Idaho] Attorney General’s Office and the governor’s legal counsel and these folks, to discuss the arrangement by which that analysis would be done,” Cameron said.
The legal rationale for Idaho’s plan, Cameron said, is that the state is tasked with “substantially enforcing” the Affordable Care Act. By linking the ACA and non-ACA plans together, and bringing cheaper and healthier customers back into the system, Idaho would strengthen its health insurance market as opposed to ridding it of the ACA plans, he said.
“People want to act like if we do nothing, everything is going to be OK; that’s not the case,” Cameron said. “People with health conditions who wouldn’t normally drop coverage will be forced to drop coverage.”
It’s now up to Azar to take action — or do nothing — in response to Idaho’s plan. The secretary told Congress earlier this month he doesn’t plan to make any move until after Cameron has signed off on Blue Cross of Idaho’s plans, which could happen as soon as March. Azar told the Idahoans the same thing this weekend, Cameron said.
At that point, Azar will probably do one of four things, Cameron said: take no action whatsoever, issue a letter saying HHS won’t enforce the law in this case, tell Idaho it’s OK to move forward as long as it makes some changes to the rules, or tell Idaho it is violating the law.
“I walked away thinking he’s a thoughtful man who’s going to have to make a legal decision as to whether we’re substantially enforcing the law,” Cameron said.
The signals were more clear when it came to the Trump administration’s reaction to a different Idaho proposal: a dual waiver that would allow uninsured, low-income Idahoans to sign up for subsidized ACA health insurance, while moving some of the sickest ACA patients to Medicaid. The Idaho Legislature is currently considering those waivers, with a work requirement tacked on to Medicaid, affecting an estimated 0.2 percent of the adults on Medicaid. The bill, however, has been delayed on the House floor and may not have the support it needs to pass.
“They applauded our innovation and creativity on the dual waivers,” Cameron said of the meeting. “They said they are looking forward to working with us to get those approved. Of course, we have to get those through the Legislature [first].”
Audrey Dutton: 208-377-6448, @IDS_Audrey