Idaho says it will allow health plans that skirt ACA rules

Affordable Care Act highlighted
Idaho's insurance director says other states may follow his lead and adopt policies exempting some health plans from ACA rules. (Getty/Ellenmck)

In a move that mirrors the Trump administration’s effort to erode the Affordable Care Act through regulation, Idaho has unveiled a plan to let health insurers sell policies that don’t comply with some of the healthcare law’s rules.

Idaho Department of Insurance Director Dean Cameron outlined the state’s plan Wednesday in a bulletin meant to be used as guidance for insurers that want to start selling skimpier coverage alongside ACA-compliant policies.

Cameron, who said he expects other states to follow Idaho’s lead, said the move is necessary to ensure consumers have access to lower-cost plans, according to the Associated Press. 

Indeed, Idaho appears to be the first state to make such a move without first getting permission from the federal government. Iowa, for example, sought—and was denied—federal approval for a waiver that would allow it to opt out of various ACA regulations.

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It’s possible that the Trump administration might allow Idaho to move ahead with its approach, health policy consultant Robert Laszewski told the AP, but it’s also likely the state’s plan would be challenged in court. 

“The bottom line is federal law pre-empts state law ... state standards can only apply when they are more demanding than the federal standards,” he said.

And as the bulletin shows, Idaho’s plan would indeed allow insurers to sell policies that adhere to less-stringent rules than those set at the federal level—provided they also sell ACA-compliant plans.

For example, plans could apply a “pre-existing condition exclusion period” to consumers who didn’t maintain continuous coverage for a set period before their plan takes effect. And coverage for maternity and newborn care would have to be included in “at least one”—but not all—non-ACA-compliant plans that an insurer offers. 

On the federal level, meanwhile, the Trump administration is getting ready to issue guidance that would exempt more people from the ACA’s individual mandate, The Washington Post reported. While the GOP’s tax bill repealed the penalty levied on those who don’t purchase health coverage, that provision won’t go into effect until 2019. 

The guidance, which is not yet finalized, would expand the number of so-called hardship exemptions people could cite on their 2018 tax returns to explain why they don’t have health insurance.