Idaho: Enrollees still have until midnight tonight to select a plan; 2020 enrollment will likely be down w/good reason.

Your Health Idaho, the states' ACA exchange, reminds residents who completed their enrollment applications that they still have until midnight tonight to actually select a policy:

Last chance to #GetCovered!
For those Idahoans who submitted an application for 2020 health insurance coverage by December 16, you have one more day to pick a plan! Do not wait! Find your perfect plan today at!

— Your Health Idaho (@YourHealthIdaho) December 23, 2019

During the 2019 Open Enrollment Period (OEP), over 94,000 Idaho residents selected on-exchange ACA policies via YHI. They haven't released their 2020 numbers yet for obvious reasons (see above), but when they do, I'm expecting it to be considerably lower...for a very good reason: Idaho finally expanded Medicaid:

The gap is a significant issue in the 14 states that have not expanded their Medicaid programs as part of the Affordable Care Act, but it is about to close in Idaho. Last year, in a ballot initiative, 62 percent of the state’s voters supported Medicaid expansion. That means Turner and 91,000 others, or about 5 percent of the state’s population, will become eligible for Medicaid coverage starting Jan. 1. Currently about 11 percent of Idaho’s residents are uninsured.

Now the income qualification is increased to about $35,500 for a family of four or $17,000 for an individual. That expansion could have a huge impact, since 15 percent of Idahoans now carry medical debt, with a median amount of $807, and have been sent to collection agencies for it, according to the Aspen Institute, a nonpartisan think tank.

...Blanksma told NBC News that her particular issue with Medicaid expansion, and one shared by many of her colleagues, is that 15,000 of the 91,000 who are now eligible for Medicaid would lose their tax credit for private health insurance and be moved to Medicaid. That has led to another waiver to expansion that would provide people a similar tax credit to buy insurance on the Idaho exchange.

“You have these 15,000 people who had good insurance, decent insurance and now they're kicked off to government assistance,” Blanksma said. “So yeah, Jan. 1 they're going to get a Medicaid card in the mail and hopefully they've been paying attention and looking at their letters so that they know that they're going Medicaid.”

But other Republicans said that for those 15,000, it’s a difference without much distinction. Those individuals are being provided federal dollars through a tax credit to buy that insurance, and Medicaid is federal dollars spent more effectively.

The article by Phil McCausland of NBC News gives a pretty good overview of the situation in Idaho, including the human benefits side as well as the political battle, but my focus here is on the 15,000 Idahoans currently enrolled in heavily subsidized ACA policies who are being shifted over to Medicaid even as I speak. Assuming all 15,000 of them are shifted, that's roughly 16% of the total.

Of course, some of those folks may be moving off of ACA policies for other reasons (death, aging into Medicare, getting a job with benefits, etc), and if YHI is doing well otherwise with outreach/etc. it's possible that some of them will be cancelled out by new enrollees earning more than 138% FPL (the Medicaid expansion cut-off point). Regardless, I'm still expecting final YHI enrollment to come in at down at least 10% this year.