Some Obamacare Requirements Can Soon Be Ignored by Idaho Insurers

by | January 9, 2018

By Cynthia Sewell, Ruth Brown, Nate Poppino

Idaho will let insurers sell private insurance plans with skimpier coverage, taking advantage of new flexibility to change certain Affordable Care Act requirements, Gov. Butch Otter said Friday morning.

Such a move would be aimed at middle-class uninsured Idahoans, including the self-employed. Otter and other officials believe those could include people in Idaho's insurance gap, who can't afford insurance but don't qualify for Obamacare subsidies or Medicaid.

The move was announced at a Friday morning preview of the 2018 legislative session, which starts Monday. Otter and legislative leaders -- House Speaker Scott Bedke, Senate Pro Tem Brent Hill, House Minority Leader Mat Erpelding and Senate Majority Leader Michelle Stennett -- took questions from the news media at the annual Associated Press Legislative Preview, held at the Capitol in Boise.

He began by looking back over his three terms in office. Speaking of the current day: "We're in great shape economically. The revenues are in great shape ... and the citizens seem to be a lot more optimistic."

He noted Idaho's low unemployment rate, but talked of more difficult-to-fill jobs in fields like medical services that he believes Idaho just isn't set up to produce right now. That's partly why education will be his top priority, he said.

"I've got great hope" for the recommendations his higher education task force produced, he said. Those include creating a "chief education officer" to lead key changes across Idaho's colleges and universities.

He spoke of a need for politicians to work together on solutions to Idaho's problems, and not just compete for news coverage and attention.

"Probably of all the things that I've learned probably in the last 11 years ... first off, we're put here to govern, we're put here to make decisions, and to not do that is shirking our responsibility."

And he sees Idaho government as needing to be "consumer-centric," with the consumers the state's entire population. "That should be our advocation and our vocation at the same time."

Idaho acquiring the HP campus in Boise: The state's annual payment on the campus off of Chinden will be "just short of $8 million," Otter said.

He believes the purchase will allow the state to both consolidate agencies and "backroom operations." HP will remain a tenant.

"Being on that campus I think will lead to a lot more efficiencies and a lot more savings for the state."

With income from HP and other tenants, the state should be able to cover the debt payments without any general fund dollars, said Bob Geddes, director of the Department of Administration. Idaho has been the landlord on the campus since Dec. 21, when the deal closed, he said.

The recent repeal of the Obamacare insurance mandate in Congress' tax overhaul can now allow Idahoans to buy private insurance plans that don't necessarily meet all of that law's criteria, the executive order argues. The order allows Dean Cameron, director of the state Department of Insurance, to seek a federal waiver for the changes if needed; it's unclear whether Idaho officials believe they need one.

The state will maintain seven key insurance requirements. Otter cited savings of 30 to 50 percent possible through the changes.

Specifics on the changes, their effects and what is needed to implement them were not immediately clear.

Otter and Little plan to tour the state in the near future to describe the health plan changes to Idahoans.

Little talked of frustration with Washington, D.C., not doing more on health care. The new executive order is "critical," he said.

"We were once some of the lowest rates in the nation. Now we are not even among the lowest rates in the Northwest," Cameron said. "Today's market is in an unhealthy spiral as the young and healthy are leaving the insurance pool.

"... Ultimately, the option of wait-and-see is no longer possible."

Cameron asked reporters to wait to see the guidelines from his department and the insurance plans that providers create before rendering judgment.

The plans will not be "skinny plans" missing key coverage, Cameron said. He called them "good plans."

The changes are still being finalized, Cameron said. Being discussed: requirements for pregnancy coverage for people who can't use them, pediatric dental care, etc. Asked about contraceptive coverage, he said he couldn't say if that would be left out of some plans but that he didn't expect that to be the case.

According to a press release sent out during Friday morning's event, the executive order will simply direct Cameron "to seek creative ways outside the restrictions of the Affordable Care Act to make health coverage more affordable for Idaho residents." Cameron hopes to have plans available as early as March. The plans would not qualify for any sort of Obamacare subsidy.

The changes are intended to encourage "the young and healthy" to rejoin insurance pools, to then benefit everyone's overall rates, Cameron said.

"Certainly, a lot of folks in the gap will be able to take advantage of these plans."

Little sent out a separate press release about the executive order Friday morning. Asked about Little -- who is running for governor -- playing a prominent role in the morning's announcement, Otter defended the lieutenant governor's involvement and pointed to other past projects Little has played key roles in.

Tax reform: Otter deferred comment on the new federal tax law to his State of the State on Monday.

Recreational marijuana: "I think it's a big mistake," Otter said of the medical marijuana movement in particular. He said governors in other states that had adopted it told him such laws created black markets. "And it'll be in the hands of every schoolkid, and it'll be in the hands of every person that wants it."

 

Legislative leadership

This panel started with an announcement that Stennett, the Senate minority leader, was stuck in traffic and would be late. She arrived about 15 minutes into the panel.

Sexual harassment: Legislative leaders will be announcing some policy changes pertaining to harassment at a training planned Tuesday for lawmakers and others who frequent the Capitol, Pro Tem Hill said.

Those will include making it easier for people to feel like they can report incidents.

"We've had sexual harassment policies for years ... and it's not like we haven't ever talked about them," Hill said.

"Let's make it clear that that type of behavior will not be tolerated in the Statehouse. And we want our policy manuals to reflect that," said Speaker Bedke.

An area will be added to the Legislature's website for people to find harassment and other important policies.

"I think there is probably room to look at our House and Senate rules for particularly staff who are working with legislators," for how they report, said Erpelding, the House minority leader. "It isn't very clear."

Bedke suggested rules wouldn't be changed, only policies.

Erpelding said the rules also need to be revisited to allow people besides just other lawmakers to file ethics complaints. Both this and the questions over harassment reporting are part of a larger issue, he said.

The revisions presented Tuesday will be a "working draft" open to further change, Hill said.

On negative, personal disputes among lawmakers: A question noted divisions that flared up at the start of the 2017 session. In particular, Bedke for a time stripped Rep. Heather Scott of her committee assignments for making disparaging remarks about how female colleagues advance in seniority.

"I certainly hope there is renewed commitment among all legislators to increase the level of civility in a way that does not thwart or limit robust debate," said Bedke. "Hopefully everyone has learned from last year and we can put it past us, forever."

On prison growth: Idaho is looking at again sending some of its inmates to other prisons out of state, to relieve overcrowding here.

Hill said further changes may come to the justice reinvestment program the state pursued in recent years to reduce prison costs and population. He talked of revisiting mandatory minimums among other issues. "There needs to be more done," Hill said.

Bedke compared the prison space issue to solving the government's office space problem through the HP campus purchase. There will be a larger fix. "In the interim, though, you have to avail yourself of some of these other options."

Stennett noted a bipartisan group of lawmakers are looking at mandatory minimums.

On mental health: Bedke noted a personal experience with suicide, replying to a question about Idaho's high suicide rate and mental health challenges. "I have done soul-searching" about how to prevent such cases, he said, and feared he didn't have many answers.

"I think that needs to start in schools," with training by teachers and counselors, he said.

Erpelding pointed to Idaho's continued high participation in its health insurance exchange. "What we know is Idahoans value access to health care," and there are areas that aren't getting proper mental health care. A funding answer, he said, is to take advantage of mental health care funds Idaho could access through Medicaid expansion.

Hill noted a shift in recent decades of how people view mental health problems, being more willing to talk about them and more willing to take them seriously. He credited the media for helping to make progress there.

"It's got to be in our education process, our families, strengthening our families ... but I think if we're going to prevent it, we've got to do it the way we prevent other serious diseases, and that is providing the care at the front end," he said.

On the many open elected positions up this year: Three of Idaho's seven statewide offices, one U.S. House seat and a number of legislative positions will not have incumbents seeking re-election this year. It's a heated campaign season to hold a legislative session during.

"It'll be like the OK Corral," Erpelding said. "It's going to be a shootout."

" 'Shootout' will have quotes around it, and we're going to conduct that in a very civil way," Bedke added. "I think many of these candidates know where the line is, and when I'm sitting in that chair I'll remind them."

On policy, Hill added: "I don't think you'll see a big turnaround" on issues by candidates running for other office.

Oil and gas: Bedke complemented the new director of the state oil and gas commission, and said he doesn't expect the issue to be quite the problem it was last year. "I think we have gone a long ways to allay the concerns that were brought up last year."

He also spoke of efforts to recharge the Eastern Snake Plain Aquifer, which runs across most of Southern Idaho, calling the work a success. "You have decades-old antagonists who have come together to fix a problem, and it's working."

On the horizon, said Erpelding: A need to address cleaning up pollution in the Middle Snake that comes from sources besides large companies, cities or other specific entities. Called "nonpoint sources," mitigating their effects must not harm key industries in the region, he said. He does not expect the topic to progress this year during the election season.

Faith healing: Bedke said the issue of faith healing is at a standstill now because there aren't enough votes to amend the existing law. Idaho Code contains several exemptions from criminal and civil penalties if a parent or guardian "chooses for his child treatment by prayer or spiritual means alone."

Multiple recent attempts to amend the law have failed, with lawmakers torn over whether removing the exemption would infringe upon people's religious freedoms.

"I have strong personal feelings on that subject," Bedke said. "But, yet, that issue has not moved."

Stennett noted that last year, legislation that was pitched to fix the issue used language that did not please lawmakers on either side.

Erpelding argued that faith has gotten in the way of children's safety.

"In this case, we continue to fail to take up children who are left to die because their parents didn't believe in basic health care," he said.

Erpelding said another example of that would be the state's refusal to amend the Human Rights Act to protect the LGBT community.

"Our record on human rights is sometimes clouded in the name of faith," he said. "And I think that's a conversation the state should have with itself."

Science standards: Last year, the Legislature amended language in science standards that would allow educators to teach students about global warming, but also teach the theory that climate change is not caused by human behavior.

Bedke said he will not "micromanage" the House Education Committee, but he supports teaching both theories.

"I think that a well-rounded education touches on all of these things, personally, and that's the type of education I had," Bedke said. "So I'm conversant in creationism and Darwinism and I think that's probably way it should be."

Erpelding called the decision an "error" and believes in future legislative sessions, the decision to teach students that climate change may not be man-made will be corrected.

"I think we'll start to see what appear to be man-made aspects of climate change and the importance of recognizing it in the next generation," he said.

Medicaid waivers: Lawmakers will consider asking the federal government for a Medicaid waiver that would allow some of Idaho's sickest adults to get insurance through Medicaid, and enable the working poor to buy health insurance plans through Idaho's insurance exchange.

"This is not Medicaid expansion," Hill said. "This is a different approach. This is an Idaho solution, and I think it is worth examining very closely."

He can't predict what the Legislature or what he himself will do with it at this point, he added.

Bedke said lawmakers will be able to "make a value judgment" once everyone is thoroughly educated on the proposal. That's the important first step, he said.

"There's an assumption that the federal government is going to give us the waivers we're asking for," Stennett noted. That may be a big hurdle, she said. She called the waivers "a path forward, not a total solution."

Erpelding said this session's proposals are interesting new ideas. But, he said, will they cause longer-term problems if they don't address fundamental mental health problems and other issues?

Federal tax reform & what Idaho does next: "It is a fascinating subject here," said Hill. "We conform, generally speaking." But Idaho doesn't conform regarding some certain rates or credits. Does Idaho create a child tax credit on the state level? Do lawmakers pursue tax reform?

"If I were guessing, I would say we go pretty close to conformity," he said, to minimize confusion and separate processes for taxpayers.

(c)2018 The Idaho Statesman (Boise, Idaho)