Idaho’s Health Care Reforms Are One Step Forward and Two Steps Back

Published March 8, 2018

Over the past five years, health care access has deteriorated in Idaho. Patients have experienced premium increases, their coverage choices have disappeared, and quality has worsened. In response, Gov. Butch Otter (R) introduced a mixed bag of initiatives to address Idaho’s health care crisis.

Otter began his initiative by signing an executive order to expand affordable health insurance options for Idaho’s residents. Under the order, Idaho insurers will be able to offer young and healthy individuals significantly discounted insurance plans. In addition, insurers will be allowed to sell plans without costly and often-unnecessary benefits, such as maternity care and pediatric services.

These rules, many of which were first imposed by the Obama administration’s Affordable Care Act, have significantly contributed to the increasing premiums in Idaho’s health insurance marketplace. Before Obamacare took effect, the average individual in Idaho could buy insurance for just $164 per month. But over the past six years, the cost of insurance has nearly tripled, to $442 per month.

Obamacare’s regulations have foisted particularly high costs on younger customers. A study by the consulting firm Mckinsey & Company estimates the law’s prohibition on discounted insurance increased premiums on young adults by 98 to 274 percent, and Obamacare’s mandated benefits raised premiums an additional 23 percent. It’s no surprise then that despite Obamacare’s goals to expand coverage, the number of young adults without insurance increased by 10 percent in 2017.

Otter’s rollback of Obamacare’s harmful regulations would deliver relief to younger patient populations and allow them to obtain coverage at an affordable price. However, while the governor’s executive order takes bold new steps toward reforming Idaho’s health care insurance market, his Medicaid proposals move the state in the wrong direction, by doubling down on Obamacare’s failures.

In his State of State Address, Otter called on state legislators to expand Medicaid to thousands of Idahoans who already rely on private health insurance for coverage. As part of his Idaho Health Care Plan, Otter seeks to force an estimated 3,000 residents with chronic conditions out of Idaho’s private health insurance exchange and into the state’s Medicaid program, including patients with cystic fibrosis, hemophilia, and bone marrow disorders. According to the proposal’s executive summary, Otter’s plan would provide a “reliable and comprehensive source of coverage” for these vulnerable patients.

Unfortunately, these vulnerable patients will likely receive worse coverage on Medicaid. As in other states, Idaho’s Medicaid program reimburses doctors only a fraction of what is provided by private insurance companies. As a result, more than 15 percent of Idaho doctors refuse to treat new Medicaid patients, according to data from the Centers for Disease Control and Prevention. This means many patients, especially those who live in the state’s rural areas, will have reduced access to medical care services.

In the words of Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, pushing Idaho’s sickest patients onto Medicaid provides them little more than a “card without care.”

Medicaid reforms should help save money while improving services. Instead, the Idaho Health Care Plan simply shifts chronically sick patients out of the private insurance market, where they receive Obamacare’s premium tax credit, and into Medicaid, which requires additional government funding and provides lower-quality care and fewer options.

Idaho shouldn’t expand upon Obamacare’s failures; it should improve the governor’s executive order by providing Medicaid patients with additional health care choices, including new and innovative health care models such as direct primary care (DPC), which provide families with a more-patient-focused experience. A study in North Carolina found patients that use DPC spend more time with their doctors and make half as many medical claims as patients with conventional, third-party primary care arrangements. Similarly, a DPC delivery model would provide Medicaid recipients with greater primary care access and lower costs for taxpayers.

Idaho should reject the flawed Idaho Health Care Plan while embracing the governor’s effort to allow pre-Obamacare health plans to be sold. This would help move Idaho away from the collapsing Obamacare model and return the power to regulate insurance back to the states and choice back to consumers, thereby encouraging competition and market freedom.