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Idaho health insurance

Four insurers offering 2020 health plans through marketplace, plus one off-exchange-only insurer; Medicaid expansion takes effect January 2020 in Idaho

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 the only state to create its own state-run health insurance exchange – Your Health Idaho – but also reject Medicaid expansion. But Medicaid expansion takes 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. Nearly 52,000 people had enrolled in Medicaid under Idaho’s new eligibility guidelines by mid-December.

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 offered 2019 plans through Your Health Idaho: Blue Cross of Idaho, Mountain Health CO-OP, PacificSource, Regence BlueShield and Select Health. All four have continued to offer coverage for 2020, and Regence is continuing to offer plans outside the exchange. The average proposed rate increase for Idaho’s individual market plans was 7 percent for 2020.

Idaho enrollment in qualified health plans

In 2015, Idaho’s state-run exchange enrolled more than 85,000 individuals in QHPs. The state was fourth in the nation in terms of per-capita enrollment and highest among all states running their own exchanges.

Enrollment grew 5 percent in 2016, with 101,073 people enrolled through Your Health Idaho. Per capita enrollment was second in the nation to Florida for 2016.

For 2018 coverage, 94,507 people signed up for health plans through Your Health Idaho. This was only 5.6 percent lower than their 2017 enrollment total, despite the fact that open enrollment was half as long. And enrollment remained very steady for 2019, with 94,430 people signing up during open enrollment.

Read more about Idaho’s health insurance exchange.

Medicaid expansion in Idaho

For several years, Idaho has been the only state that implemented a state-run marketplace but rejected Medicaid expansion. But that’s changing in 2020, after voters passed a Medicaid expansion ballot initiative in the 2018 election. Medicaid expansion in Idaho takes effect January 1, 2020, and eligible residents can begin enrolling on November 1, 2019.

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 will no longer be a coverage gap in Idaho after the end of 2019.

Read more about Medicaid expansion in Idaho.

Short-term health insurance in Idaho

Idaho regulations do not limit the initial term of short-term policies, so new federal short-term regulations apply in the state. That means insurers may offer short-term plans with initial terms up to 364 days.

Plans that renew beyond that duration are subject to state regulations, including guaranteed renewability. So the portion of the new federal rule that allows short-term plans, with renewal, to have total durations up to 36 months does not apply in Idaho.

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

Idaho Medicare enrollment reached 331,104 as of mid-2019. That’s about 18.4 percent of the state’s population, which is fairly consistent with the percentage of the U.S. population enrolled in Medicare. Eighty-six percent of Idaho Medicare recipients qualify for the program based on age alone, while the rest are enrolled in Medicare as the result of a disability.

Idaho’s Medicare spending is below the national average. Medicare pays about $7,478 per Idaho enrollee each year, and the state ranks 42nd in overall Medicare spending with $1.75 billion annually.

Most Idaho Medicare beneficiaries have the option to select a Medicare Advantage plan instead of Original Medicare, although there are several counties in northern and central Idaho where there are no Medicare Advantage plans available. But about 34 percent of Idaho recipients opt for Medicare Advantage instead of traditional Medicare, which is the same as the national average.

Medicare recipients in the state of Idaho can also purchase Medicare Part D plans to gain stand-alone prescription drug coverage, and about 38 percent do so. Forty-five percent of all Medicare recipients nationwide choose these Rx 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: