Idaho

Freedom's just another word for..."better not get sick."

In Idaho, "Freedom" comes with limits
— Zachary Tracer (@ZTracer) February 14, 2018

— Katherine Hempstead (@khemp64) February 14, 2018

Two weeks ago, Idaho Governor "Butch" Otter issued an executive order allowing insurance carriers to basically just ignore federal law altogether and start offering non-ACA compliant healthcare policies. As Sarah Kliff of Vox.com noted at the time:

Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.

So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.

The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.

Idaho is one of only 2 state-based exchanges which stuck with the "official" December 15th deadline for the 2018 Open Enrollment Period (the other was Vermont). Unfortunately, they haven't released an official, detailed demographic breakout report yet, but they did discuss some relevant stats in their December board meeting...which, as it happens, took place on December 15th, which means it's still missing a bit of final data. For now this is the best I can do:

d) Enrollment Update

Mr. Kelly said YHI’s goal in enrollments is to be flat year-over-year, and it is within reach. When we look at average enrollments for 2017 of around 90,000 Idahoan’s, we appear to be ahead of that for 2018. As of this morning, we have almost 96,000 enrollments. This week alone, we have gained over 6,000 enrollments, way ahead of our growth for the same time last year. We also had well over 2,100 calls into the support center yesterday.

 

Last year, after 7 years of doing everything in their power to undermine, sabotage and weaken the ACA, Congressional Republicans tried every which way they could to repeal the law. They tried passing AHCA , B-CRAP, ORRA, Graham-Cassidy and a few other variants along the way to no avail.

Finally, in late December, desperate for a win on "repealing Obamacare"--any type of win--they said "screw it" and just repealed the ACA's individual mandate all by itself. They didn't replace it with a reasonable inducement for people to get covered, mind you, against the advice of actuarial expert advice, mind you; they just...got rid of it.

The vote to repeal the mandate penalty was incredibly short-sighted and will almost certainly lead to negative consequences when it actually goes into effect (which won't be until next year, causing much confusion until then, but that's a different discussion)...but at least it's legal.

The same can't be said for Idaho's decision last week to simply ignore federal law altogether in the future:

Breaking News from Your Health Idaho:

Despite Changes, Idahoans Flock to Health Insurance Exchange
2018 Enrollment Nears Record

BOISE, Idaho – Your Health Idaho announced today that nearly 102,000 Idahoans signed up for 2018 health insurance coverage on the exchange.

“This is a testament to Idaho’s model for operating an exchange. Despite the enormous uncertainty from Washington, combined with a shortened enrollment period, Your Health Idaho has been able to serve near record numbers of Idahoans,” said Pat Kelly, executive director of Your Health Idaho.

The enrollment numbers include new and returning customers. A significant difference for 2018 is the monthly premium pricing. Increased tax credits offset rising premiums to the extent that some Idahoans purchased plans for little to no monthly cost. Enrollments in these less expensive bronze plans increased by fifteen percentage points over the previous year. In total, 101,793 Idahoans enrolled in 2018 health coverage in just half the time of last year.

I've been expecting the first and third of these developments:

MARYLAND Open enrollment extended by one week:

OPEN ENROLLMENT EXTENDED UNTIL DEC. 22
ONE WEEK ADDED TO ENROLL IN 2018 HEALTH, DENTAL COVERAGE

BALTIMORE (DEC. 13, 2017) – Open enrollment through Maryland Health Connection has been extended until Friday, Dec. 22 to choose a plan for health coverage to begin Jan. 1, 2018, with expanded call center hours through next week.

Individuals can apply at MarylandHealthConnection.gov or through the “Enroll MHC” mobile app available free in the App Store (iOS) and the Google Play Store (Android).

Also, hundreds of insurance brokers and navigators around the state can help Marylanders apply for financial help and enroll in a plan. Their locations and contact information are available at MarylandHealthConnection.gov or through a GPS-enabled locator tool on the app.

A week ago I noted that total Idaho exchange enrollments had reached around 87,000 people as of 11/30. Today Your Health Idaho confirmed that they're "nearing 90,000" enrollments for 2018, which is about where they expected it to be at this point. They also noted that call volume and web traffic are still ahead of last year.

Not much else to say other than ID has reached about 90% of their highest enrollment tally (they had 101,073 QHP selections in 2016 and 100,082 last year) with a week left to go. Last year they had enrolled 91,509 people as of December 10th, but of course the final deadline is a week from today instead of January 31st this time around, so they'd need to add another 10,000 over the next week to match last year's tally.

Thanks to "Andy the Dog" for the heads up:

Kelly said about 90,000 people were insured through the exchange at any given time this year. (People could enroll or cancel during the year.) And at the end of last year’s open-enrollment period, more than 100,000 were signed up for coverage.

This month, the exchange has renewed 86,300 customers for 2018 plans. The new sign-ups are much lower, in the hundreds. Kelly said total enrollment so far — 2017 customers being rolled over into 2018, plus the new sign-ups — exceeds 87,000.

“That number has grown every day in the last several weeks,” he said.

Less than 10 percent of people who were auto-renewed for 2018 plans have canceled so far, he said. More people could cancel by the deadline, though; last year, almost 30 percent of auto-renewed plans had been canceled when the dust settled on the enrollment period.

Your Health Idaho just sent out the following press release:

Preview Health and Dental Plans on Your Health Idaho
Shorter Enrollment Period November 1 - December 15

BOISE, Idaho – Today, Idahoans can get a preview on YourHealthIdaho.org of the 299 health and dental insurance plans being offered on the exchange in 2018, and how much help may be available to them.

“Insurance rates will be higher next year, but tax credits will increase to keep pace. Idahoans are often surprised at how much they can save on their health insurance through the exchange. “By going online now, consumers can check to see if they are eligible for tax credits to lower the cost of premiums,” said Pat Kelly, Your Health Idaho executive director. Consumers can take the savings information to comparison shop for the right plan.

The Idaho Insurance Dept. has made things pretty easy for me. While they don't break out the individual market enrollment numbers by insurance carrier, they do provide the statewide, weighted average of those enrollees: 27% approved vs. the 38% average which was requested  requested (assuming no CSR reimbursement payments)

Idaho is a bit of an odd duck when it comes to the ACA. On the one hand, they're the only state completely controlled by Republicans to set up their own ACA exchange (Kentucky's much-lauded "kynect" exchange was created by Democratic Governor Steve Beshear by executive order...and was then promptly scrapped the moment that incoming GOP Governor Matt Bevin took office). On the other hand, they're also the only state with their own exchange not to expand Medicaid. (As an aside, ID is also the only state to start out on the federal exchange the first year before breaking out onto their own exchange website).

It feels almost silly for me to spend so much time crunching the average 2018 rate hike numbers at this point. Between the (supposedly failed?) GOP repeal effort and Donald Trump's ongoing sabotage efforts--including what could be him officially pulling the plug on CSR reimbursements as early as sometime today--it's probably a bit of a futile effort. Besides, a dozen other wonks/analyses have already confirmed what the Kaiser Family Foundation projected months ago and which I've been proving on a state-by-state basis for months now: The CSR threat is causing average rate hikes of around 20 points on average, and the threats to individual mandate enforcement are tacking on another 4-5 points on top of that, beyond the ~10 points which rates would normally be increasing on average.

However, I've plugged in 21 states, so I might as well finish the job. With that in mind, the state of Idaho has done most of the dirty work for me:

Between updating the "Who could lose coverage" graphics, prepping for my town hall thing last night and updating the 2018 Rate Hike project, I've gotten way behind on my "Who's saying 'screw rate hikes, I'm just gonna bail completely next year' updates. Let's take care of that now, OK? The first three updates are courtesy of Louise Norris writing for healthinsurance.org; the fourth is vai Kimberly Leonard for the Washington Examiner:

IDAHO: BridgeSpan is out, 4 carriers staying put:

Insurers in Idaho had to submit forms for 2018 plans by May 15, but they have until June 2 to file rates. Mountain Health CO-OP, SelectHealth, PacificSource and Blue Cross of Idaho all filed forms to continue to offer Your Health Idaho plans in 2018.

The Washington Post features an interesting story by Robert Samuels about Idaho's ongoing failure to come up with a solution to their self-imposed "Medicaid Gap" problem:

Here in Idaho, Gov. C.L. “Butch” Otter, a Republican, vowed to come up with a replacement after declining to fully embrace the Medicaid expansion that was offered as part of the Affordable Care Act. He’s tried to persuade his heavily Republican legislature to set aside their hands-off views about the government on this issue. Studies have been conducted. Proposals have been put forward. But after four years, lawmakers have come up with no alternative.

“While it is clear there is broad agreement on the fact there is a problem, agreement on what to do about it is another story,” Otter wrote in a statement to The Washington Post.

Your Health Idaho just released their final OE4 enrollment tally, and it's not bad at all:

A record number of Idahoans signed up for health insurance coverage through the statebased health insurance exchange during the latest open enrollment period, which ended on January 31.

“Over the last three months, more than 105,000 people selected a health insurance plan through the exchange,” said Pat Kelly, executive director of Your Health Idaho. “We have never seen more interest in Your Health Idaho. We know changes are coming to the health insurance marketplace but we want our customers to know our entire team remains committed to serving them and providing them with access to affordable health insurance options.”

In total, 105,977 Idahoans signed up for coverage through Your Health Idaho during the 2017 open enrollment period.

For the past three years, Idaho has been the leader in per-capita enrollments for state-based exchanges. YHI is currently waiting on nationwide enrollment numbers to determine how it ranks for the 2017 open enrollment period.

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