The Trump administration issued a written warning to Idaho on Thursday that an audacious maneuver by the state to allow health plans that fall outside the Affordable Care Act’s insurance rules “may not be substantially enforcing” the law.
The warning, in a letter to Idaho’s governor and insurance director by the administrator of the federal Centers for Medicare and Medicaid Services, does not immediately block the state’s unique decision to encourage insurers to sell health coverage lacking some benefits required by the law, such as maternity care or certain coverage of pre-existing conditions. The letter is a strong signal, however, that the Health and Human Services department is unwilling to allow Idaho to move forward on its own.
As the controversy surrounding Idaho’s maneuver has spread from the state to Washington, many legal and health policy experts have called it illegal.
However, in an interview early Thursday evening, Dean Cameron, Idaho’s insurance director, quickly suggested that the state is not prepared to give up.
How the administration would respond to a rebel state’s attempt to create a parallel insurance universe for individual buyers has been widely considered a significant test of HHS Secretary Alex Azar in his initial weeks on the job. The issue calls on him to balance President Donald Trump’s — and his own — eagerness to free states and consumers from the ACA’s dictates with his avowed commitment to adhere to the law.
Asked by Democrats in Congress and journalists how he planned to respond, Azar has said repeatedly in recent weeks that he did not want to be “premature.” He said there was no reason for HHS to consider whether to step in unless Idaho insurance regulators approved such alternative health plans for sale.
In the end, though, federal officials did not wait.
Blue Cross of Idaho, the biggest insurer in the state’s ACA marketplace, has submitted five Blues Freedom plans to the state’s insurance regulators for approval. Cameron said that his department was still evaluating the plans and recommending tweaks.
The letter to Idaho Gov. C.L. “Butch” Otter, a Republican, and Cameron, straddles the Trump administration’s antipathy for the ACA with its need to enforce the 2010 health-care law that is a path to insurance coverage for millions of Americans.
The letter suggests that “with certain modifications” Idaho could offer individual coverage that deviates from the ACA’s rules by defining them as short-term health plans.
