Idaho chimes in on the Special Enrollment Period issue with a "unique situation"

For a couple of weeks now, I've been posting constant updates as one state-based ACA exchange after another has announced a COVID-19-specific Special Enrollment Period in light of the ongoing pandemic crisis. Until now, though, there's been two ACA exchanges which haven't made such an announcement. One is the Big One, HealthCare.Gov, which hosts a whopping 38 states and which is facing increasing pressure to do so.

The other...is Idaho. Specifically, Your Health Idaho, the state's ACA exchange.

Idaho's exchange story is kind of interesting. Not the exchange itself, which is pretty straightforward; they were hosted by HealthCare.Gov for the very first Open Enrollment Period before splitting off onto their own full state-based exchange the following year. Unlike many ACA exchanges, Idaho's launched pretty much without a hitch and has been quietly operating year after year without much drama.

What is interesting is the fact that Idaho set up their own exchange in the first place. ID is a pretty deep-red state, and Republicans have controlled both the Governor's office as well as both the state House and Senate for years. They are therefore the only "red trifecta" state to ever establish their own full ACA exchange. Even Kentucky's famous "kynect" exchange was only possible because a Democratic governor was able to do so via executive order over the objections of a GOP-controlled legislature (and it was promptly scrapped the moment a Republican took the governor's office).

In short, Idaho is the only fully red state to take the "as long as we're stuck with the ACA, we might as well do it our way!" attitude, which is actually exactly what the Obama Administration was hoping other GOP states would do in the first place.

Anyway, I contacted the exchange last week to see what the deal was re. a COVID-19 SEP and they kicked the ball over to the state Insurance Dept:

COVID-19 (coronavirus) is not currently considered grounds for a Special Enrollment Period in Idaho. Questions around the potential offering of an SEP would be best answered by the Idaho Department of Insurance. This really falls within their regulatory authority. YHI will follow their guidance and support whatever decision is made.

I did indeed contact the Idaho DOI, but I didn't hear back from them until today. Here's what they had to say:

Thank you for reaching out. We are continually monitoring the situation daily under the direction of Idaho’s Office of the Governor. While it is our understanding that a diagnosis of a disease is not currently criteria for a Special Enrollment Period, we are aware that there is national discussions about adding one regarding COVID-19. Idaho is in a somewhat unique situation in that two health insurers are offering individuals in Idaho an ongoing enrollment option with the fully-comprehensive Enhanced Short Term Plans, so anyone who wishes to purchase major medical coverage today can obtain it. We will continue to assess, and have not ruled out any future actions.

I admit I had completely forgotten about this.

Normally, I'm stronly opposed to so-called "Short-Term, Limited Duration" healthcare plans (aka STLDs, or #ShortAssPlans as I often refer to them), and with good reason: They're oftentimes junk plans with a long history of fraud, fine print, hidden charges...and even what they're upfront about is often pretty unpleasant: They're medically underwritten, which means they can deny coverage to those with pre-existing conditions; they usually have huge gaps in coverage, often leaving out multiple Essential Health Benefits; they have annual and lifetime coverage limits; and oftentimes 50% or more of your premium dollars goes to the carrier's bottom line.

In other words, STLDs are generally the exact type of swiss cheese/"junk" plans which the ACA was trying to discourage in the first place.

Idaho's version of "short-term plans", however, is a little different. I'm still not thrilled about them, but as Louise Norris explains, they're not nearly as bad as the #ShortAssPlans I often write about:

Idaho now has two types of short-term plans: Regular non-renewable short-term plans cannot have terms in excess of six months. But “enhanced” short-term plans, which follow a different set of rules, can have terms up to 364 days and are guaranteed renewable for up to 36 months. Idaho’s rules for these plans are extensive, and go well beyond the Trump administration’s regulations that took effect in 2018.

...Blue Cross of Idaho began selling enhanced short-term plans as of December 1, 2019, and SelectHealth has filed paperwork with the state to also begin offering the plans (SERFF filing number SLCT-132118836 is for coverage that could be effective as soon as January 2020. As of early December, the filing is pending regulatory approval).

...Allowing enhanced short-term plans to be sold through the exchange would obviously be controversial. The ACA only allows qualified health plans to be sold through a state’s exchange, and these enhanced short-term plans — while certainly better than short-term plans in most states — are not qualified health plans.

Premium subsidies would not be available to offset the cost of the enhanced short-term plans in the exchange, but the idea is that they would be a lower-cost option for people who would otherwise be uninsured or covered under lower quality short-term plans, health care sharing ministry plans, fixed indemnity plans, etc.

...Rulemaking activity for Idaho’s new enhanced short-term plans is available here. The state published temporary rules that took effect in July 2019, and a proposed final rule was published in October 2019.

  • Insurers can choose to offer year-round availability or to limit enrollment to the same enrollment window that applies to ACA-compliant plans. If the plan is available year-round, the insurer can impose a waiting period for pre-existing conditions. If the plan is only available during open enrollment, no pre-existing condition waiting period can be applied (SelectHealth and Blue Cross of Idaho have both filed forms indicating that their plans will have waiting periods for pre-existing conditions).
  • Insurers that offer enhanced short-term plans must also offer qualified health plans through Your Health Idaho (the state-run exchange) in the same areas.
  • Enhanced short-term plans must be offered on a guaranteed-issue basis (but insurers can base premiums on medical history, and can impose a waiting period for pre-existing conditions).
  • Coverage under an enhanced short-term plan is considered qualifying coverage that allows a person’s pre-existing condition waiting period to be waived. So if a person renews their short-term plan after the first year, there will no longer be any waiting periods for pre-existing conditions during the second year.
  • Enhanced short-term plans must be guaranteed renewable (for up to 36 months of total duration). The insurer cannot require a new application or new medical history questions during the renewal process.
  • Although the plans are capped at 36 months (in accordance with federal rules for short-term plans), insurers are required to allow enrollees to re-enroll in a new plan after the first one expires, and no new application or medical history questions can be used.
  • When a person has had coverage under an enhanced short-term plan for at least 11 months and the policy is terminating, they are eligible to enroll in any of the insurer’s ACA-compliant plans at that point (regardless of whether open enrollment is underway).
  • Enhanced short-term plans cannot vary rates based on gender, although they can use an applicant’s medical history to set rates.
  • Geographic rating areas must be the same as the rating areas used for ACA-compliant plans.
  • Enhanced short-term plan enrollees must be incorporated into the same risk pool as the insurer’s other individual market enrollees.

In other words, they sort of split the difference between traditional #ShortAssPlans and fully ACA-compliant Qualified Health Plans (QHPs). STLDs can have stingy annual limits; QHPs can't have any; "enhanced" STLDs have to have a minimum of $1 million. STLDs don't have guaranteed issue or community rating; QHPs have both; "enhanced" STLDs have the former but not the latter, and so on.

Again, this is a very slippery slope (especially the idea of offering them alongside QHPs on the exchange), but for good or for bad, they're a thing in Idaho at the moment.

In any event, the main point here is that Idaho is saying that they don't have as much need of a COVID-19 SEP because their "enhanced" Short-term Plans are a) available year-round (like normal #ShortAssPlans) but b) are also guaranteed issue w/some other regulations and thus are considered "fully comprehensive" to use the ID DOI's wording.

I'm not so sure I agree with that description, but as long as they're required to cover COVID-19 testing and treatment, I supposed it's an acceptable answer to my specific question, anyway.

Of course, the "year round availability, guaranteed issue" requirements are kind of cancelled out by the whole "waiting periods for pre-existing conditions" clause, so I'm not sure I agree with they're logic here. I still hope they issue a COVID-19 SEP regardless.