Idaho’s plan to cover its poorest residents through the Affordable Care Act exchange, while moving some of the exchange’s most expensive patients onto Medicaid, cleared its first hurdle Wednesday.
The House Health and Welfare Committee voted 7-5 to pass a bill that allows the state to seek federal waivers for the plan, then implement it if the federal government approves those waivers. The vote followed about three hours of testimony; speakers in favor included patient advocates and representatives of the health care industry.
The plan was developed mainly by the Idaho Department of Health and Welfare, the Idaho Department of Insurance and Your Health Idaho, the state’s health insurance exchange.
It would do two things:
▪ Take about 2,500 of Idaho’s sickest adults out of the pool of people enrolled on exchange plans, moving them instead to Medicaid insurance. Those patients drive a huge share of medical spending on exchange plans, which drives up premiums and worsens the trend of healthy people dropping out of the exchange, officials told the committee.
▪ Allow working-poor Idahoans to buy health insurance on the exchange, with federal subsidies to cover their premiums. An estimated 78,000 people in Idaho are uninsured because they’re too poor to qualify for exchange subsidies but don’t qualify for Idaho’s stringent Medicaid program. The new plan would allow about half of those people to get private insurance instead of going on Medicaid.
The bill also imposes a work requirement on “able-bodied” adults who receive Medicaid benefits. That requirement was slotted into the bill at the request of some legislators; it’s otherwise unrelated to the waivers, because the waivers wouldn’t add able-bodied Idahoans to Medicaid. The state estimates the work requirement would affect about 700 people — or 0.2 percent of the Idahoans currently on Medicaid.
If Idaho’s waivers are approved, it would cost the state about $29 million — Idaho’s share of the cost of medical bills for people who would be moved onto Medicaid. The federal government would pick up about $72 million for that Medicaid shift. Idaho wouldn’t pay anything for insuring poor Idahoans through the exchange.
One major goal of the plan is to stabilize the exchange market, where premiums are rising and insurers are losing money. Idaho Department of Insurance Director Dean Cameron told the committee that if the bill didn’t pass, he “can promise you … rates will be 20 percent higher than they would be otherwise,” he said. “Carriers will continue to see losses and, eventually, my prediction is, they will begin to withdraw from the marketplace.”
Committee members such as Rep. Bryan Zollinger, R-Idaho Falls, asked if that would be a “bailout” of health insurance companies — relieving them of a huge chunk of their expenses. Cameron argued that it’s not a bailout because the insurers would have to pass any net savings on to consumers in the form of lower premiums.
Jim Baugh, executive director of DisAbility Rights Idaho, told the committee that moving people with severe, often disabling health conditions onto Medicaid would offer them an added benefit: Medicaid covers a lot of services that private insurance doesn’t, such as home care.