Article written by Julie Appleby: jappleby@kff.org, @Julie_ApplebyThat didn’t take long.
It’s barely been two weeks since Idaho regulators said they would allow the sale of health insurance that does not meet all of the Affordable Care Act’s requirements — a controversial step some experts said would likely draw legal scrutiny and, potentially, federal fines for any insurer that jumped in.
On Wednesday, Blue Cross of Idaho unveiled a menu of new health plans that break with federal health law rules in several ways, including setting premiums based on applicants’ health.
“We’re trying to offer a choice that allows the middle class to get back into insurance coverage,” said Dave Jeppesen, the insurer’s executive vice president for consumer health care.
The firm filed five plans to the state for approval and hopes to start selling them as soon as next month.
The Blue Cross decision ups the ante for Alex Azar, the Trump administration’s new Health and Human Services secretary. Will he use his authority under federal law to compel Idaho to follow the ACA and reject the Blues plans? Or will he allow state regulators to move forward, perhaps prompting other states to take more sweeping actions?
At a congressional hearing Wednesday, even as Blue Cross rolled out its plans, Azar faced such questions.
“There are rules. There is a rule of law that we need to enforce,” Azar said. Observers noted, however, he did not specifically indicate whether the federal government would step in.
Robert Laszewski, a consultant and former insurance industry executive, thinks it should.
“If Idaho is able to do this, it will mean other … states will do the same thing,” he said. “If a state can ignore federal law on this, it can ignore federal law on everything.”
Idaho’s move stirs up more issues about individual insurance market stability
Policy experts say that allowing lower-cost plans that don’t meet the ACA’s standards to become more widespread will pull younger and healthier people out of Obamacare, raising prices for those who remain. Supporters say that is already happening, so this simply provides more choices for people who earn too much to qualify for subsidies to help them purchase ACA coverage.
The state’s move to allow such plans, announced in January, drew harsh and swift criticism.
“Crazypants illegal,” tweeted Nicholas Bagley, a law professor at the University of Michigan and former attorney with the civil division of the U.S. Department of Justice, who said that states can’t pick and choose which parts of federal law to follow. Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, pointed out that health insurers could be liable for sharp fines if they are found to be in violation of the ACA.
But both Idaho regulators and Blue Cross officials say they are not worried.
Jeppesen said the ACA gives states regulatory authority “to make sure the market works and is stable,” and the insurer is simply “following what the state has given us guidance” to do.
Other insurers in Idaho are taking a much more cautious approach, telling The Wall Street Journalthey are not stepping up immediately to offer their own plans.
Laszewski said they are likely waiting to see what legal challenges develop.
“If I were running an insurance company, there’s no way I would stick my neck out until the high court has ruled in favor of this — and they’re not going to,” he said.
Jeppesen said his company has consulted with legal experts and is moving ahead with confidence. The aim is to bring people back into the market, particularly the young, the healthy and those who don’t get a tax credit subsidy and can’t afford an ACA plan.
For some people — especially younger or healthier applicants — the new plans, which the insurer has named Freedom Blue, cost less per month than policies that meet all ACA rules.
They accomplish that by limiting coverage. If they are allowed to be sold, consumers will need to weigh the lower premiums against some of the coverage restrictions and variable premiums and deductibles, policy experts say.
The plans, for example, will include a “waiting period” of up to 12 months for any preexisting conditions if the applicant has been without coverage for more than 63 days, Jeppesen said.
Additionally, they cap total medical care coverage at $1 million annually. And premiums are based, in part, on a person’s health: The healthiest consumers get rates 50 percent below standard levels, while those deemed unhealthy would be charged 50 percent more.
All those caveats violate ACA rules, which forbid insurers from rejecting coverage of preexisting conditions or setting dollar caps on benefits or higher premiums for people with health problems.
But the rates may prove attractive to some.
Premiums for a healthy 45-year-old, for example, could be as low as $195 a month, according to a comparison issued by the insurer, while a 45-year-old with health problems could be charged $526. In that case, the 45-year old would find a lower price tag — $343 a month — for an ACA-compliant bronze plan.
While Freedom Blues plans cover many of the “essential health benefits” required under the ACA, such as hospitalization, emergency care and mental health treatment, they do not include pediatric dental or vision coverage. One of the five plans does not include maternity coverage.
When compared with one of the Blues’ ACA-compliant plans — called the Bronze 5500 — the new standard Freedom Blue plan’s annual deductibles are a mixed bag.
That’s because they have two separate deductibles — one for medical care and one for drugs. If a consumer took only generic drugs, the new plan would be less expensive, according to details provided by the plan. But with a $4,000 deductible for brand-name drugs, the Freedom Blue plan requires more upfront money before full coverage kicks in than the ACA-compliant plan it was compared with.
Jeppesen said the insurer hopes to attract many of the “110,000 uninsured state residents who cannot afford [ACA] coverage.”
That’s the total number of uninsured people who earn more than 100 percent of the federal poverty level in the state, he said.
Sarah Lueck, senior policy analyst for the Center on Budget and Policy Priorities, cautioned that some of those residents might actually be eligible for subsidies under the ACA, which are available to people earning up to four times as much.
“Many … could be getting subsidies for more comprehensive coverage through the [ACA-compliant state exchange] and would be better off,” Lueck said.
For KFF, republished here in full as graciously allowed by KFF under their creative common license.
Some of you may remember this as the Cruz ammendant, published last year after the first BCRA died in the Senate.
Since the Cruz ammendant, based in part on this initiative failed, Idaho governor decided to sign an executive order authorising this the beginning of this month and now Blue Cross has created 5 non ACA plans.
This. Is. Blatently. Illegal.
So, what does the HHS secretary Aziz says?
https://www.vox.com/policy-and-politics ... ho-voxcareMr. Azar said the decision last month by the Idaho Department of Insurance to let insurers offer consumer plans that could charge higher premium rates to people with pre-existing conditions was a sign that too many people can’t afford coverage under the ACA.
“What we’re seeing here is a cry for help,” Mr. Azar said. Idaho officials have said they made the change to provide lower-cost options for consumers because of increases in ACA plan premiums
Yes. Despite it being Trump fault for causing the rise in premiums, we should totally violate the laws of the land to help the people .
http://amp.idahostatesman.com/news/poli ... 55194.html
Same hearing, different paper
I didn't know Idaho is violating the law here . What does the governor and lt governor of the Great state of potatoes say?At a Senate Finance Committee hearing Thursday, Azar first told a concerned Sen. Ron Wyden, D-Ore., that he would wait until Idaho officials sent a waiver application, then measure “it up against the standards of the law.” When Wyden said Idaho was moving forward without a waiver, Azar suggested that he would wait until the state reviews the plans – which Blue Cross created in response to a solicit from the state
Teehee. The law will only sue the insurance companies, not me! That's why I have no time to care that I breaking the law .Otter and Little, meanwhile, appear unconcerned about any possible action against the state.
Otter said he wasn’t sure how the state government would factor into a lawsuit when the insurers are the ones actually selling the plans. “The insurance companies are the ones that get sued, not Idaho,” he said.
And Little? “Lt. Gov. Little believes he can’t be worried about the threat of lawsuits when he should be worried about affordability and choice in health care,” Bilbao wrote. “Little also believes like many Idahoans do, that it is time for the government to stop telling us what we can or cannot do.
Oh. Why am I doing this?
Vote for me for governor, because I terminated Obamacare folks!!After the public signing, the pair toured the state to defend and explain the health insurance order – necessary, Otter said, because of immediate criticisms and confusion over the plans. Meanwhile, Little has posted on social media and written in guest columns about “ending Obamacare for many Idahoans.” Tommy Ahlquist, one of Little’s Republican competitors, quickly accused Little last month of “campaigning on Idaho taxpayer dollars.”
Oh well. What does the insurance coy say?
https://www.npr.org/sections/health-sho ... eral-rules
Ja, I was just following orders.Jeppesen said the ACA gives states regulatory authority "to make sure the market works and is stable," and the insurer is simply "following what the state has given us guidance" to do.
An actual Nuremberg defence!!! Weeeeee!!!!!
What does the senator of Idaho say?
https://www.politico.com/story/2018/02/ ... nce-347961
I do what I want, you got that punk?“We’re a state; we don’t need approval,” Sen. Jim Risch (R-Idaho) said Wednesday. “Get out of here.”
Oh well. What does the law say?
https://www.healthaffairs.org/do/10.137 ... 7094/full/In the 1999 regulations, HHS adopted fairly extensive rules governing when HHS steps in to enforce federal law. Under 45 C.F.R. 150.203, the agency laid out the circumstances in which HHS would step in to enforce, including when a state notified HHS that it was not enforcing federal law or if HHS made its own determination based on information it had received or obtained. HHS also outlined the different sources of information that might trigger an investigation of state enforcement. These include complaints, information learned during contact between HHS and state officials, media reports, information from governors and insurance commissioners, and “any other information that indicates a possible failure to substantially enforce.” These provisions remain in effect today.
Given this authority, the widespread news coverage of Idaho’s approach, and a letter yesterday from patient advocates, HHS Secretary Alex Azar has more than enough grounds to initiate an investigation into whether the DOI is substantially enforcing the ACA. If the DOI is not doing so, HHS is obligated under federal law and its own regulations to step in and do so. HHS must then follow the procedures outlined in 45 C.F.R. 150 Subparts B and C to make a preliminary determination of noncompliance, provide notice to the state, and then make a final determination. States can resume enforcement responsibilities if they enact and implement legislation and if HHS determines that it is appropriate to do so.
Stop right there you criminal scum! Oh wait, you a thane? I took an arrow to the knee, Carry on.
So.... Here you have it folks. Your government, refusing to listen to the democratic opinion of it's citizens, refusing to enforce it laws, refuse to follow it's legal and democratic process and lawmakers telling the 4th estate to go fuck off, we can do whatever we want.
America.
