Health insurance in Idaho
- Idaho enrolls through Your Health Idaho, a state-run health insurance exchange.
- Open enrollment runs from November 1 through December 15.
- Five insurers are offering 2019 coverage through the Idaho exchange.
- The average premium increase for 2019 is 5 percent.
- About 95,000 enrolled in 2018 coverage through the Idaho exchange.
- Idaho has not accepted ACA’s Medicaid expansion.
- Insurers in Idaho may offer short-term plans with initial terms up to 364 days.
Idaho’s health marketplace
Idaho was the only state to create its own state-run health insurance exchange – Your Health Idaho – but also reject Medicaid expansion. The model seems to be working, with the state near the top of per-capita exchange enrollment.
Five insurers are offering 2019 plans through Your Health Idaho: Blue Cross of Idaho, Mountain Health CO-OP, PacificSource, Regence BlueShield and Select Health. Approved 2019 rate increases for those insurers averaged 5 percent.
Idaho’s exchange included plans from four carriers in 2018. On average, approved rate increases for 2018 individual plans ranged from 26 to 31 percent.
Read more about Idaho’s health insurance exchange.
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.
Medicaid expansion in Idaho
Idaho is the only state that implemented a state-run marketplace but rejected Medicaid expansion. Because Idaho has thus-far rejected federal funding to expand Medicaid under the Affordable Care Act (ACA), an estimated 119,000 residents are in the coverage gap — ineligible for subsidies in the exchange and also ineligible for Medicaid.
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 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.
While Idaho elected to run its own health insurance exchange, it opted not to expand Medicaid under the Affordable Care Act. Were the state to expand Medicaid to low-income adults, it is likely its uninsured rate would see greater improvement as has been the case in other states that have expanded Medicaid, created a state-run exchange or both.
In a July 2015 progress report evaluating states by how patient-centered their health insurance markets, Idaho was among the lowest-scoring states. The report notes that Medicaid expansion would help it improve in the continuity of care metric.
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, and Raúl Labrador has since replaced him in the U.S. House. 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 HealthCare.gov to sign up for coverage in 2014.
For 2015 open enrollment, Your Health Idaho completed its transition to a state-run exchange and began 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.
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 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.
Idaho Medicare enrollment
Idaho Medicare enrollment reached 282,024 in 2015, about 17 percent of the state’s population, which is consistent with the percentage of the U.S. population enrolled in Medicare. Eighty-four percent of Idaho Medicare recipients qualify for the program based on age alone, while the balance are on 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.
Idaho Medicare beneficiaries may select a Medicare Advantage plan instead of original Medicare if they wish to gain some additional benefits. In 2015, about 32 percent of Idaho recipients opted for Medicare Advantage instead of traditional Medicare, while 31 percent made this selection nationwide.
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
Here’s a look at state-level legislation that would affect health reform in Idaho: