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Idaho health insurance

Four insurers offering 2020 health plans through marketplace, plus one off-exchange-only insurer; Medicaid expansion took effect January 2020 in Idaho, and "enhanced" short-term plans are also available as of 2020

Health insurance in Idaho

Idaho’s health marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

How hard is Idaho fighting to preserve the Affordable Care Act’s provisions? Compare to other states’ efforts.

Idaho was initially the only state to create its own state-run health insurance exchange (Your Health Idaho) but also reject Medicaid expansion. But Medicaid expansion took effect in Idaho on January 1, 2020 — six years after it began in states that accepted it as soon as it was available — thanks to a ballot initiative that voters passed in the 2018 election. Enrollment in the state’s newly-expanded Medicaid program began November 1, 2019. More than 65,000 people had enrolled in Medicaid under Idaho’s new eligibility guidelines by late February 2020.

Open enrollment for private plans through Your Health Idaho has ended. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020. Outside of the open enrollment window, regular major medical health coverage in the individual market can only be purchased by Idaho residents who have qualifying events.

Four insurers are offering 2020 plans through Your Health Idaho: Blue Cross of Idaho, Mountain Health CO-OP, PacificSource, Regence BlueShield and Select Health. Another insurer, Regence, offers plans only outside the exchange. The average approved rate increase for Idaho’s individual market plans was 6 percent for 2020.

During the open enrollment period for 2020 health plans, more than 89,000 people signed up for private individual market plans through Your Health Idaho. This was about 14,000 fewer than the year before, primarily due to Idaho’s implementation of Medicaid expansion. In 2019 and prior years, people with income of at least 100 percent of the poverty level were eligible for subsidies to purchase private plans in the exchange. But as of 2020, people with income up to 138 percent of the poverty level are eligible for Medicaid instead, resulting in fewer people enrolled in private individual market coverage.

Read more about Idaho’s health insurance exchange.

Medicaid expansion in Idaho

For several years, Idaho was the only state that implemented a state-run marketplace but rejected Medicaid expansion. But that changed in 2020, after voters passed a Medicaid expansion ballot initiative in the 2018 election. Medicaid expansion in Idaho took effect January 1, 2020, and eligible residents were able to begin enrolling on November 1, 2019. By February 2020, enrollment in Idaho’s expanded Medicaid had surpassed 65,000 people.

Prior to 2020, an estimated 119,000 Idaho residents are in the coverage gap — ineligible for subsidies in the exchange and also ineligible for Medicaid. But there is no longer a coverage gap in Idaho after the end of 2019.

Read more about Medicaid expansion in Idaho.

Short-term health insurance in Idaho

Idaho allows two types of short-term plans, which have differing regulations. Normal short-term plans in the state are non-renewable and cannot have terms in excess of six months. But the state allowed for the creation of new “enhanced” short-term plans that are available as of 2020 with longer terms and much more robust benefits and consumer protections.

Read more about short-term health insurance in Idaho.

How has Obamacare helped Idaho?

The uninsured rate in Idaho dropped 6.1 percentage points to 10.1 percent between 2013 and 2016, according to U.S. Census data. Nationwide, the uninsured rate fell to 8.6 percent in the same time period, but it started out a little lower than Idaho’s, with 14.5 percent of the national population uninsured in 2013, versus 16.2 percent of Idaho’s population.

By 2018, the uninsured rate in Idaho had inched back up to 11.1 percent (nationwide, there was an increase in the uninsured rate from 2017 to 2018), but it’s expected to drop sharply in 2020, when Medicaid expansion takes effect.

The state’s exchange, Your Health Idaho, has been called a “model for state-based adoption [of an exchange]” for its below-average budget, lean organizational structure and strong financial controls.

Idaho and the Affordable Care Act

Idaho is a solidly “red” state, and many politicians and residents staunchly oppose the Affordable Care Act. At the federal level, both Idaho senators voted against the ACA in 2010, as did one of two representatives. Rep. Walt Minnick (D) was the sole “yes” vote from Idaho; Raúl Labrador subsequently replaced him in the U.S. House, serving until 2019 when Russ Fulcher became the Representative from Idaho’s 1st Congressional District. Like Labrador, Fulcher opposes the ACA.

Idaho is one of the only Republican-controlled states that implemented a state-run marketplace. Former Gov. Butch Otter, while critical of the ACA, advocated for a state-run marketplace as a better option than the federally facilitated marketplace. Legislation authorizing the state-run exchange, which is named Your Health Idaho, passed and was signed into law in 2013.

With not enough time to get all functions operational before ACA’s open enrollment period, Idaho residents used to sign up for coverage in 2014.

By the fall of 2014, in time for open enrollment for 2015 coverage, Your Health Idaho completed its successful transition to a state-run exchange and began operating independently of the federal marketplace. Your Health Idaho has continued to be a fully state-run exchange, utilizing its own enrollment platform, since 2015.

Does Idaho have a high-risk pool?

Before the ACA’s individual health insurance market reforms, coverage was medically underwritten in nearly every state, including Idaho.  People with pre-existing conditions were often unable to purchase private plans, or could only get policies that excluded their pre-existing conditions or charged them increased premiums because of their medical history.

The Idaho Individual High-Risk Reinsurance Pool (HRP) was created in 2001 to give people an alternative means of obtaining coverage if they were unable to purchase a private plan because of their medical history. By 2010, there were 1,565 members in the Idaho HRP.

Idaho’s HRP had a fairly unique design, in that each insurer in the state was required to participate, and had to offer five standardized HRP plans. If a person applied for individual market coverage and the insurer’s underwriting determined that the applicant would be a high risk, they would be able to select from among the five HRP plans offered by that insurer instead, with premiums capped at no more than 150 percent of the premiums charged for healthy enrollees in the non-HRP plans.

One of the primary reforms brought about by the ACA is guaranteed issue individual coverage; medical history is no longer taken into consideration when an application is submitted. Thus the need for high-risk pools has largely disappeared, and the Idaho risk pool stopped enrolling new members at the end of 2013. But the plan has not yet terminated coverage for existing members; they can voluntarily transition to the exchange unless notified otherwise by the HRP.

Idaho Medicare enrollment

As of late 2019, there were 337,802 Idaho residents enrolled in Medicare. You can read more about Medicare in Idaho, including details about Medicare Advantage, Part D coverage, and the state’s rules for Medigap plans.

State-level reform legislation in Idaho

Scroll to the bottom of this page for a look at state-level legislation related to health care reform in Idaho: