Proposed 2016 rates
Rates are currently under review in Idaho, and will be finalized over the next several weeks. The Idaho Department of Insurance rate review page and Healthcare.gov’s rate review tool both only display proposed rate increases of ten percent of more. Of the five carriers selling individual health plans through Your Health Idaho, three have proposed double-digit rate hikes for 2016:
- Blue Cross of Idaho = 24.28 percent
- BridgeSpan = 6.3 percent (BridgeSpan shows up on both rate tools, indicating that a double-digit rate hike was proposed. On Healthcare.gov’s rate review page, it shows BridgeSpan’s proposed rate change as 12.81 percent, but the justification confirms the same 6.3 percent that shows up on the Idaho Division of Insurance site).
- Montana Health CO-OP (Mountain Health CO-OP in Idaho) = 25.75 percent for LINK plans and 22.88 percent for Access Care (average = 25.4 percent)
- SelectHealth = 14.68 percent
- PacificSource does not appear on either rate review publication, so we can assume that they have proposed a single digit rate increase (or even a decrease); for 2015, PacificSource had rate increases in excess of 30 percent for their individual market exchange plans in Idaho.
Assessment fee rising to 1.99%
Your Health Idaho is funded with a 1.5 percent assessment fee on all health insurance plans sold through the exchange (unlike many other states, the fee is not collected for plans sold outside the exchange). That will be increasing to 1.99 percent in 2016, which is still considerably lower than the 3.5 percent assessment that Healthcare.gov collects in states that use the federally-faciliated marketplace.
The exchange does not receive any state funding. They are currently still using federal start-up grant money, but that will be gone by the end of the year and the exchange will need to be financially self-sustaining in 2016, which is why the assessment has been increased. The board has approved a $9.7 million operational budget for 2016, plus a $15 million project budget.
Room for improvement
In July, the National Health Council released a progress report that evaluated every state in terms of how patient-centered its health insurance market is. Idaho was one of 14 states that scored the lowest on the report, and it’s the only one of those 14 states that has its own state-run exchange (Utah was also among the low-scorers, and although it has a state-run exchange, it’s only for small businesses, not for individuals).
The areas where Idaho ranked poorly included uniformity (how easy it is for exchange enrollees to understand and compare plans) and continuity of care (how easy it is for exchange enrollees to transition from one plan to another – the report notes that expanding Medicaid would make a big improvement for this metric). On three other metrics, Idaho received an average score: state oversight of exchange plans, transparency in exchange plans, and non-discrimination in plan design.
2015 enrollment data
During the second open enrollment period, Idaho ranked fourth in the nation in terms of per-capita enrollment in the exchange. Only three states (Maine, Georgia, and Florida) had higher per-capita exchange enrollment, and they all use Healthcare.gov. Idaho’s per-capita enrollment was the highest of the state-run exchanges.
Idahoans had until Feb. 15 to complete an application on Your Health Idaho and until Feb. 21 to finalize their plan selections. As of Feb. 21, the exchange had enrolled 97,079 people in private plans for 2015. But some of them didn’t pay their initial premiums (meaning their coverage was never effectuated), and some people cancelled their coverage early in the year. By the end of March, 84,987 people had in-force private plan coverage through Your Health Idaho. 81.3 percent are receiving premium subsidies, and 62.3 percent are receiving cost-sharing subsidies (only available on silver plans for enrollees with incomes up to 250 percent of the poverty level).
By mid-April, effectuated enrollments had climbed slightly to 85,128 people, despite the fact that Idaho was one of only three states in the US that didn’t offer a special enrollment period (SEP) to accommodate consumers who didn’t know – until they filed their taxes – that there was a penalty for being uninsured.
An additional 314,398 exchange enrollees had qualified for Medicaid between Nov. 15 and Feb. 22.
With some exceptions, individuals who missed 2015 open enrollment are out of luck for getting private health insurance this year. However, those who experience a qualifying life event can enroll within 60 days of the event. Native Americans can enroll anytime during the year. In addition, qualifying individuals can sign up for Medicaid throughout the year.
No impact from King v. Burwell
Because Idaho switched to being a fully state-run marketplace in 2015, subsidies were not in danger of being eliminated in the King v. Burwell lawsuit. Ultimately, the Supreme Court ruled that subsidies are legal in every state, even those that rely on Healthcare.gov. Although the verdict didn’t impact Idaho one way or the other, the state’s Congressional delegation – all Republicans – were largely unimpressed by the Court’s decision. But Gov. Butch Otter, also a Republican, praised the state’s efforts to establish and run an exchange, thereby insulating the state’s residents from any potential fallout from the King case.
State-run marketplace launch is ‘flawless’
Your Health Idaho transitioned to its own platform for the ACA’s second open enrollment period, and the launch was “absolutely flawless” according to the exchange’s executive director.
Idaho relied on HealthCare.gov, the federal exchange, for enrollment functions during the first open enrollment period. To get ready for 2015, Idaho transitioned to its own technology. The move paid off as 2015 open enrollment on Your Health Idaho was very successful.
Your Health Idaho touts a low assessment fee as one of biggest consumer benefits to running its own exchange. For both 2014 and 2015 policies, Your Health Idaho charged an assessment fee of 1.5 percent of premium cost. On the federal marketplace, the fee is 3.5 percent.
You can browse 2015 rates and estimate your subsidy on Your Health Idaho.
New insurer joins Your Health Idaho
A new insurer was approved by the Idaho Department of Insurance for 2015: Mountain Health CO-OP, which is the Idaho branch of Montana Health CO-OP. The CO-OP joins Blue Cross of Idaho, BridgeSpan Health Company, PacificSource Health Plans, and SelectHealth, all of which returned to the exchange for 2015.
2014 enrollment recap
More than 76,000 Idahoans signed up for health insurance during the first enrollment period. That’s 36,000 more than the target set by the federal government, and in a state of only 1.7 million people, the per-capita enrollment ranks Idaho third in the nation for plans purchased during the first open enrollment period.
Among Idaho residents selecting a QHP, 92 percent qualified for financial assistance, compared to 85 percent nationally. Only Mississippi and Wyoming had higher rates of individuals eligible for assistance. A report released in June by the U.S. Department of Health and Human Services showed the average monthly premium, after tax credits, for Idaho consumers was $68. Fifty percent of those Idaho enrollees who qualified for subsidies pay $50 or less per month after subsidies.
During the 2014 open enrollment period, 15 percent of Idaho residents selected a bronze plan (20 percent nationally), 72 percent selected a silver plan (65 percent nationally), 10 percent selected a gold plan (9 percent nationally), 3 percent selected a platinum plan (5 percent nationally) and 1 percent selected a catastrophic plan (2 percent nationally). Twenty-seven percent of Idaho enrollees were between the ages of 18 and 34.
Agents and brokers: key to success
Your Health Idaho created a strong partnership with agents and brokers in the state, and 50 percent of the exchange’s 2014 enrollments were facilitated by agents and brokers. Your Health Idaho refers to agents and brokers as the “backbone” of the exchange, and credits the partnership with them as the main factor that drove enrollment in 2014.
History of Idaho’s marketplace development
Republican Gov. Butch Otter announced in December 2012 that Idaho would implement a state-run health insurance exchange, and HHS gave conditional approval of the state’s plan in early January 2013.
The state-run option was resisted by both the governor and many Republican legislators. Like those in other “red” states, Idaho leaders hoped the U.S. Supreme Court would find the Affordable Care Act (ACA) unconstitutional. However, after the Court upheld most elements of the ACA and a state task force in October 2012 strongly recommended a state-run exchange, Otter began leaning toward that option as preferable to a federally run exchange.
After Otter’s announcement in December 2012, legislators began considering legislation, and both chambers passed bills authorizing a state-run in exchange in the first quarter of 2013. However, that left scant time to set up the exchange.Idaho used the federal site for the first open enrollment period, but transitioned to its state-run platform in time for the 2015 open enrollment period.
Idaho is the only state that opted to build its own marketplace, but decided against expanding eligibility for its Medicaid program. According to the Kaiser Family Foundation, the decision means about 51,000 Idahoans fall into the coverage gap — meaning they don’t qualify for Medicaid or for subsidies to help them purchase private coverage.
The Medicaid Redesign Group, appointed by Otter, has repeatedly supported Medicaid expansion, most recently in November 2014. The workgroup’s latest recommendation is to extend Medicaid eligibility to adults up to 100 percent of the federal poverty level (FPL) and provide subsidies to help those between 100 and 138 percent of FPL to purchase private coverage through Your Health Idaho. The workgroup also supports a pilot program to use money from the state’s catastrophic care fund to purchase health insurance for people in the Medicaid gap.
In his 2015 State of State address, Otter asked state legislators to consider the recommendations from the Medicaid Redesign Group. Republican leaders said they were open to discussing the recommendations, but stopped far short of endorsing expansion.
Idaho health insurance exchange links
Your Health Idaho
Idaho Health Insurance Exchange
This site provides information about exchange planning and start-up; a consumer-facing site is under development.
State Exchange Profile: Idaho
The Henry J. Kaiser Family Foundation overview of Idaho’s progress toward creating a state health insurance exchange.
Idaho Department of Insurance
Answers questions about insurance bought on the individual market and insurance provided by an employer who only does business in Idaho.
(208) 334-4250 / toll-free (800) 721-3272