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Idaho health insurance

'Red state' has 5th best enrollment of potential exchange users

Many factors influence public health, including the prevalence of various diseases, smoking and obesity rates, access to health care, and the affordability of health insurance. This overview discusses Idaho’s health rankings and summarizes how the state has responded to the Affordable Care Act.

Idaho health ratings

Idaho ranks 31st in overall health in the 2014 Scorecard on State Health System Performance, two positions higher than in the 2009 scorecard. The ranking compares various health indicators and gives each state and the District of Columbia a composite score. See Idaho’s Scorecard for its performance on the individual measures.

Idaho fairs much better in the America’s Health Rankings, which looks at a different set of health indicators. Idaho ranks 12th in the 2013 survey, up seven positions from 2012. Idaho has one of the nation’s lowest smoking rates. It also ranks well for a low rate of preventable hospitalizations and a low prevalence of low birth weight babies. Idaho’s public health challenges include limited availability of primary care doctors and low childhood immunization rates.

The 2014 edition of Trust for America’s Health also scores Idaho on a variety of public health measures; however, it doesn’t provide a composite score. See Key Health Data About Idaho.

If statewide data is too general, you can review county-by-county health rankings for Idaho from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

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, and he has since been replaced in the U.S. House by Raúl Labrador. Labrador is in favor of repealing the ACA.

Idaho is one of the only Republican-controlled states that implemented a state-run marketplace. 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.

For 2015 open enrollment, Your Health Idaho completed its transition to a state-run exchange and is operating independently of the federal marketplace. Your Health Idaho reported a successful launch, with the executive director saying he was “really, really pleased” with the site’s performance during the first days of open enrollment.

How did the ACA help Idaho?

The uninsured rate in Idaho dropped 3.3 percentage points between 2013 and mid-2014, according to Gallup. The average drop was 2.2 percentage points among states that implemented either a state-run marketplace or Medicaid expansion or implemented neither of those measures.

Idaho enrollment in QHPs

Just more than 76,000 Idaho residents enrolled in qualified health plans (QHPs) during 2014 open enrollment. At 37.7 percent, Idaho ranked 5th in the nation for the percentage of potential marketplace users who actually enrolled in a QHP. The national average was 28 percent.

Four insurers sold individual policies on Your Health Idaho for 2014: Blue Cross of Idaho, BridgeSpan, PacificSource, and Select Health. These companies are continuing on the Idaho marketplace in 2015.

In addition,  Mountain Health CO-OP joined Your Health Idaho for 2015 open enrollment. Mountain Health CO-OP is an offshoot of Montana Health CO-OP. The insurers were launched with the help of the ACA’s Consumer Operated and Oriented Plan (CO-OP) Program, and are intended to increase competition. See a map of states where CO-OPs were funded.

Idaho’s Medicaid Program

Idaho is the only state that implemented a state-run marketplace, but not Medicaid expansion. According to the Kaiser Family Foundation, the decision against expansion leaves about 55,000 low-income, non-elderly adults in the coverage gap – meaning they don’t qualify for Medicaid or for subsidies to help them purchase private coverage.

In Idaho, non-disabled adults without dependent children are not eligible for Medicaid. Medicaid is only available for parents of dependent children if their household income is under 27 percent of the federal poverty level.

As of August 2014, enrollment in Idaho Medicaid was 275,274. Medicaid enrollment has increased about 10 percent since the fall of 2013.

Learn about Idaho Medicaid and the State Children’s Health Insurance Program (SCHIP).

Does Idaho have a high-risk pool?

Before the ACA’s individual health insurance market reforms, coverage was 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.

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.

State-level reform legislation in ID

Here’s a look at state-level legislation that would affect health reform in Idaho: