Federal sign-off on Idaho solution? Wait and see.

By Melissa Davlin, Idaho Reports

Two health care plans — one an executive order on health insurance, and one a legislative proposal on Medicaid waivers — are touted as Idaho solutions to rising health care costs.

But sometimes, even state solutions need permission from the federal government. Right now, there’s no guarantee that permission will come.

In a Thursday interview with Idaho Reports, Idaho Department of Insurance Director Dean Cameron said both the executive order and the dual waiver proposal would need sign-off from the feds. When asked if he was confident that blessing would come, Cameron answered “We’ll see, won’t we?”

The executive order directs Cameron to create guidelines for insurance plans to be sold in Idaho that wouldn’t necessarily meet the mandates outlined in the Affordable Care Act. That wouldn’t need permission from the feds so much as the federal government’s inaction — in other words, declining to come after Idaho for non-compliant plans.

“We believe that when the president and Congress… repealed the individual mandate, that meant consumers didn’t have to buy ACA compliant plans,” Cameron said. “That means they can buy something else.”

But that belief hasn’t yet been tested, Cameron said.

The federal government has a few chances to comment on Idaho’s plans: When Idaho issues its guidelines, and when insurance companies create insurance plans to fit those guidelines. Right now, Cameron is working on putting together guidelines for insurance providers on what must be covered.

Jon Hanian, spokesman for Gov. C.L. “Butch” Otter, pointed to President Donald Trump’s inclination toward deregulation as a sign of hope for the Idaho efforts.

“We have been and continue to be in constant contact with federal officials on this issue. They’re asking questions and we’re answering.”

“As of right now, they’re taking a wait-and-see approach,” Hanian said.

Another proposal, more uncertainty

The dual waiver proposal also needs sign-off — and unlike the executive order, it requires the federal government to take action.

Here’s how it works: One waiver would allow individuals with incomes under 100 percent of the federal poverty line to receive cost-share reductions and tax credits meant for buying insurance on the private market. The other waiver allows Idahoans with “medically complex diagnoses” — essentially, long-term conditions that are expensive to treat — to move to Medicaid.

The federal government hasn’t OKed the first part of the proposal regarding the tax credits. Without that first waiver, the second part of the proposal doesn’t work.

Lt. Gov. Brad Little, who also signed the executive order, emphasized the difference between the insurance executive order and the Medicaid dual waiver legislative proposal.

“Of course, (the feds) are in the same place,” Little said. “Everyone was expecting a repeal and replace, and all we’ve done is kind of banged up the Affordable Care Act.”

Cameron and Hanian said despite the uncertainty on both proposals, the Department of Insurance is in constant contact with DC.

“We’re… trying to walk a fine line between what would be acceptable and what would be unacceptable to the federal government,” Cameron said.

“We’re in touch with them every step of the way so that it doesn’t run into any problems and it would avoid any potential” issues, Hanian said.

The Jan. 19th episode of Idaho Reports also featured Rep. Fred Wood, chairman of the House Health and Welfare committee, and Sen. Maryanne Jordan, member of the Senate Health and Welfare committee, discussing the merits of the proposals.

We’ll have much more on health care throughout the season. You can watch the full episode of Idaho Reports here, or watch the extended interview here.

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