For the past year, the Trump administration and Republicans in Congress have led a charge to roll back the Affordable Care Act, signaling an openness to state changes.
Now, Idaho has jumped in, saying it will allow insurers to ignore some ACA rules on plans not sold on the marketplace, aiming to make these state-based plans less costly. Several of the changes are viewed by the law’s supporters as hits to its core consumer protections.
Critics decried the move, saying Idaho can’t unilaterally decide not to follow federal law, including some of the ACA’s protections for preexisting conditions and its limits on how much more insurers can charge older or sick people.
Idaho’s approach has national implications because of a key underlying question: Will the administration push back to compel Idaho to follow the ACA or offer a green light that could prompt other states to take even more sweeping action?
Idaho argues its aim is to bring people back into the market, particularly the young, the healthy and those who can’t afford an ACA plan.
“That’s our goal,” said Dean Cameron, director of the state’s Department of Insurance. “Our goal is not to take away from the ACA, but to add to it or complement it.” For instance, insurers could veer from the ACA rules in creating the new plans, so long as they offer other ACA-compliant policies.
Premiums for marketplace policies have risen sharply amid continuing GOP efforts to undermine the ACA. Middle-income Americans who don’t get subsidies are struggling to afford coverage.
“States are trying to figure out what they can do,” said Ed Haislmaier, a senior research fellow at the conservative Heritage Foundation. “How do you provide them with cheaper insurance?”
Idaho says the answer is to skip some of the ACA rules.
Can Idaho do this?
Many experts say no. IHPI member Nicholas Bagley, a law professor at U-M and former attorney with the civil division of the U.S. Department of Justice, tweeted early Thursday that the move was “crazypants illegal.”
In a follow-up call, he explained that the ACA created rules that — among other things — prevent insurers from discriminating against people based on their health or excluding coverage for those conditions.
“I’m completely flummoxed,” he said. “Idaho appears to be claiming they do not have to adhere to federal law.”