Health and Human Services Secretary Alex Azar will sit down with Idaho’s insurance commissioner and governor on Saturday, and the topic of the state’s plan to overhaul Obamacare is likely to be front and center in their meeting.
This is the first discussion Azar will have with Republican Gov. Butch Otter and Dean Cameron, director of the Idaho Department of Insurance, since the state laid out a plan to allow health insurance companies to sell coverage that does not abide by Obamacare’s rules.
“It is the first time he will have had a chance to hear directly from us,” Cameron told the Washington Examiner.
Under Idaho’s proposal, insurers could sell policies that allow certain customers to be charged more based on a pre-existing illness such as diabetes if they did not have coverage the previous year. It also wouldn’t require coverage for children’s vision or dental care, and would require that only one plan offer maternity coverage, rather than all plans, as Obamacare stipulates. Insurers still would need to offer at least one plan that abides by all of Obamacare’s rules.
The proposal gives more customers less expensive options for coverage, but pro-Obamacare advocates and Democrats are concerned the plans will strain the exchanges and offer inadequate consumer protections.
Azar was questioned about what he would do regarding Idaho’s proposal during budget hearings in the House and Senate last week. When asked about it again by reporters Tuesday, Azar said he wanted to first be able to review the idea before taking a position.
“I’m not in a position to rule on something that I’ve seen a media report about,” he said. “Let’s see where the state of Idaho ends up, and then, I can work with the administrator of [the Center for Medicare and Medicaid Services]. I just don’t believe in premature opinions on complex, important topics or serious weighty matters. But at the right time, I’m sure we will have views.”
Otter is already in Washington, and Cameron was heading there to attend the National Governors Association’s annual meeting. Several governors are expected to meet with Azar and other officials from the Trump administration during that time.
Cameron said his state has documentation to give to Azar and said he expects that Azar will need time to review it, that he does not expect a decision will be made during the meeting.
“I’m not the person who organized the meeting, so I’m not sure it’ll be the only topic of conversation,” Cameron said about the state’s plan for Obamacare. “But I would expect since questioned by the media and by members of Congress about it, that we are anticipating having an opportunity to answer some of his questions.”
Cameron already has discussed the state’s Obamacare proposal with Randy Pate, deputy administrator and director of the federal Center for Consumer Information and Insurance Oversight, which is part of the Department of Health and Human Services. He also discussed it with Tom Price, who ran HHS before resigning in October amid reports that he used private jets for travel, resulting in $1 million in government costs.
“I don’t want to portray that HHS or CCIIO or any employee there has given us a green light, but they also haven’t given us a red light,” Cameron said. “They have simply asked questions, very appropriate questions, that we think they should ask and we are happy to answer.”
Legal experts have questioned whether Idaho’s proposal is allowed under Obamacare, formally known as the Affordable Care Act, but it could still move forward if the Trump administration decides to overlook it. Nicholas Bagley, a regulatory law expert from University of Michigan Law School, who supports Obamacare, said in a Vox column that precedent set under the Obama administration allowing states to flout the law could bolster Idaho’s position.
Cameron says the state is abiding by the correct regulations, particularly because it obligates insurers to sell at least one Obamacare plan.
“We know that our role under the ACA is to substantially enforce the law. We believe that we are meeting all of the conditions of substantially enforcing the law,” Cameron said. “We don’t believe there is any evidence to show that we aren’t. ACA plans will be available and consumers who wish to purchase ACA plans will have that opportunity and privilege.”
Blue Cross of Idaho has submitted plans to the state’s insurance division, which are being reviewed. Cameron said they could be sold as early as April 1, and residents would be allowed to buy them at any time. Under Obamacare, most customers can buy plans only during a limited open enrollment period unless they have exempting life circumstances such as a move or divorce.
If Azar decides to block Idaho’s plans, one option he will have is to sanction Blue Cross of Idaho, which would carry a maximum penalty of $100 a day per enrollee.
Democrats have urged him to act, warning that the efforts in Idaho could be replicated elsewhere and would unravel Obamacare. On Thursday, they sent a letter to Idaho’s insurance department saying that they opposed the proposal, and asking the state to provide documents and an analysis of the medical plans and how they would affect rates of uninsured, as well as the stability of the state’s marketplace.
Cameron hasn’t received the letter but said he would respond to requests for information when he does.
“I found it ironic that the media received it before I did,” he said. “It says to me the actual motives of the letter aren’t intended to sincerely obtain information but to garner media attention.”
Cameron stresses that the proposal Idaho has come up with is strictly what state officials believe is right for their residents, though he acknowledges that dozens of other state insurance commissioners have contacted to him to discuss the plan. Some are considering replicating it, while others are not, he said.
For Idaho, he and other officials determined that many of those left in the exchanges tend to be sicker and tend to receive a government subsidy that makes health insurance less expensive for them. They are aiming to provide options for healthier residents who do not get help paying for plans. By doing so, they hope they will return to the marketplace so they can help spread the risks and lower costs overall.
“I believe our proposal is garnering a lot of attention because a number of states are facing similar situations,” Cameron said. “There is a fear that this is a crack in the dam that would be replicated in other states, but I’m not doing it so it can be replicated. We made the proposal based on what is best for Idaho.”
He supports proposals in Congress that would aim to stabilize Obamacare by funding insurer payments as well as reinsurance, but said that his proposal was still needed. The pending legislation, which may be included as part of an omnibus spending bill, is a “Band-aid,” he said.
“We have all waited patiently for Congress to fix the problems with the ACA and they have been unsuccessful and there is no remote sign they’ll be successful in the immediate future,” he said. “In the meantime, hundreds of thousands of Idahoans are being forced out of coverage and don’t have an opportunity to protect themselves.”
