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Idaho health insurance exchange / marketplace

93k enrollments by Dec 18; exchange now financially self-sustaining

  • By
  • healthinsurance.org contributor
  • January 4, 2016

Open enrollment underway

Open enrollment for 2016 started on November 1, and continues until January 31. By December 18, Your Health Idaho had enrolled 93,000 people in private plans for 2016. The exchange noted that their current in-force enrollment (in plans for 2015) at that point was about 86,000 people – virtually the same as it had been in mid-2015, when Your Health Idaho had 85,981 people with in-force coverage.

During the 2015 open enrollment period a year ago, 97,079 people selected coverage in private plans by the end of open enrollment. For 2016, the exchange was just 4,000 people shy of that number, with six weeks left in open enrollment.

Enrollees who want to have coverage effective February 1 must sign up by January 15. Your Health Idaho is a state-run exchange, and is offering a total of 211 health and dental plans for 2016 (adult dental will be offered through Your Health Idaho for the first time in 2016; previously the exchange only sold pediatric dental).

Your Health Idaho used Healthcare.gov’s enrollment platform in 2014, but switched to being a fully state-run exchange in time for the 2015 open enrollment period. Your Health Idaho’s Executive Director Pat Kelly has said that the exchange worked hard to make sure that round three would be even better than last year, noting that “we’ve worked tirelessly over the last 9 months to improve our technology, make it easier for consumers, and also for those agents and brokers.

Your Health Idaho debuted anonymous browsing for 2016 plans on their website starting October 1 – a full month ahead of the start of open enrollment. California had already enabled browsing, but Idaho and Maryland became the second and third states to do so in advance of the 2016 open enrollment period. Your Health Idaho didn’t previously have an anonymous browsing tool at all, so this was a big improvement for the exchange.

2016 rates and carriers

Of the five carriers selling individual health plans through Your Health Idaho, three proposed double-digit rate hikes for 2016: Blue Cross Blue Shield of Idaho, Mountain Health CO-OP, and SelectHealth. Rates were finalized by regulators at the end of August, and ACAsignups’ Charles Gaba has filled in some additional details.

  • Blue Cross of Idaho = proposed average rate hike of 24.28 percent (average approved rate increase is 23 percent).
  • BridgeSpan = proposed average rate hike of 6.3 percent (average approved rate increase is 7 percent). BridgeSpan is a sister company to Regence Blue Shield of Idaho; BridgeSpan was established specifically to offer policies through Your Health Idaho.
  • Montana Health CO-OP (Mountain Health CO-OP in Idaho; an ACA-created CO-OP) = proposed average rate hikes of 25.75 percent for LINK plans and 22.88 percent for Access Care; overall proposed average = 25.4 percent. (approved average rate increase is 26 percent).
  • SelectHealth = 14.68 percent (approved average rate increase is 15 percent)
  • PacificSource = In 2015, PacificSource had rate increases in excess of 30 percent for their individual market exchange plans in Idaho. But for 2016, regulators approved an 8 percent decrease.

Two additional carriers offered individual coverage outside the exchange in Idaho in 2015: Regence Blue Shield and Time. Regence had an average rate increase of 10 percent for 2016, but Time exited the insurance market nationwide and is no longer offering coverage anywhere for 2016.

There exchange is also offering dental coverage from five carriers: Dentegra (new for 2016), BEST Life and Health Insurance Company, Delta Dental of Idaho, The Guardian Life Insurance Company of America, and Willamette Dental.

There are not any Platinum plans available in the Idaho exchange for 2016. Only about 2 percent of Idaho exchange enrollees selected platinum plans in 2015, and the carriers opted not to offer those plans in 2016, as they aren’t required by the ACA and clearly were not a popular choice among enrollees.

For the most part, approved rates in Idaho are virtually the same as the proposed rates, although the Idaho Department of Insurance noted that they were able to work with carriers to reduce the overall rate hikes on some plans, particularly at the Silver and Bronze level. But the DOI explained that “carriers propose rates based on claims experience, premiums, network provider agreements, administrative and other costs. Based on these criteria, the Department could not find the carrier rate proposals to be unreasonable.” Hence, rates were mostly finalized as-proposed.

Kaiser Family Foundation analyzed data on benchmark plan (second-lowest-cost Silver plan) premium changes from 2015 to 2016 in metropolitan areas across the country. In Boise, they found that the average benchmark plan for a 40-year-old non-smoker would be increasing from $210/month to $273/month – a 30 percent increase, which is three times the average they found nationwide.

But that’s before any premium subsidies are applied. If that 40-year-old applicant is earning $30,000 in both 2015 and 2016, and is willing to switch plans in order to still have the benchmark plan in 2016 (the second-lowest-cost Silver plan won’t necessarily be from the same carrier that offered it the year before), the after subsidy premium will actually be slightly lower in 2016 than it was in 2015, because the subsidy will increase to offset the higher premiums (the poverty level is also slightly higher, so if enrollees have the same income they had last year, their income is now a slightly lower percentage of the poverty level, making them eligible for a slightly higher subsidy).

In 2015, nearly 82 percent of Your Health Idaho enrollees are receiving premium subsidies that average $227/month. Since the cost of the benchmark plans across Idaho will be increasing in 2016, the average subsidy will also be increasing, and more enrollees will qualify for subsidies in 2016.

CO-OP still solvent

By the end of October, 11 of the 23 CO-OPs created by the ACA had closed or announced they would close by year-end. But Montana Health CO-OP (which operates as Mountain Health CO-OP in Idaho) appears to be on somewhat solid ground. CEO Jerry Dworak noted that the CO-OP didn’t expand too quickly, and maintained substantial reserves; they were not relying as heavily on risk corridor payments to shore up their financial position (as Charles Gaba has noted, the CEO’s proclamation that they’re doing well doesn’t necessarily mean they don’t have financial troubles – but for now, they managed to avoid being shut down by regulators, which is more than can be said for almost half of the CO-OPs).

The CO-OP was due to receive $6 million in risk corridor payments, and ultimately only received 12.6 percent of that amount (just like all of the other carriers that were owed risk corridor payments). But unlike eight other CO-OPs that were doomed by the risk corridor shortfall and shut down by the end of 2015, Montana Health/Mountain Health CO-OP is still viable heading into 2016. Their average rates increased by 26 percent, but that’s very comparable to the average rate hike for BCBS of Idaho.

Assessment fee increases to 1.99%

Your Health Idaho was previously 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).  The fee has increased 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 received $104 million in federal funds for 2014 and 2015, but most of that money has already been spent, although the exchange notes that they have about $6 million in cash reserves. The exchange must be self-sustaining going forward, 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 2015, 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 were receiving premium subsidies, and 62.3 percent were 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. And by the end of June, effectuated enrollment stood at 85,981. Nationwide, there was a dip in effectuated enrollment numbers from March to June, but Idaho added almost a thousand effectuated enrollments during that time.

An additional 314,398 exchange enrollees qualified for Medicaid between Nov. 15 and Feb. 22. Medicaid enrollment continues year-round, but it tends to increase during open enrollment due to outreach activities.

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 was ‘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. Idaho’s assessment increased slightly in 2016, to 1.99 percent, but is still considerably lower than Healthcare.gov.

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 joined Blue Cross of Idaho, BridgeSpan Health Company, PacificSource Health Plans, and SelectHealth, all of which returned to the exchange for 2015. The same five carriers are offering coverage in 2016.

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.

70 percent of enrollments in the Idaho exchange in 2015 were completed with the assistance of brokers, which is far higher than most other states and reflects Your Health Idaho’s commitment to partnering with brokers.

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 30,000 (possibly as many as 78,000) 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. The workgroup has recommended the Healthy Idaho Plan, which would 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. The Idaho Medical Association has asked lawmakers to support the Healthy Idaho Plan.

Idaho health insurance exchange links

Your Health Idaho
855-YHIdaho (855-944-3246)

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

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