The 2013 Idaho Legislature passed the Idaho Health Insurance Exchange Act, which led to the creation of an Idaho-controlled health insurance exchange doing business under the name Your Health Idaho.
This column follows up on our column of April 2013 and is our attempt to provide a picture of YHI’s status, one year after passage of the Act. As a matter of full disclosure, our law firm has been retained as counsel to YHI and we have had the privilege of representing YHI during the past year. Through our work, we have found that, even after a year of operation, many are not aware of exactly what the Act does, what an exchange is, and how it affects the lives of Idahoans.
The debate over a health insurance exchange, which dominated the 2013 legislative session and which continues on a much lesser scale, arises because the Patient Protection and Affordable Care Act of 2010 requires the establishment of health insurance exchanges to serve the individual and small-employer-group markets (collectively, “ACA”). In Idaho, a vocal minority opposed the creation of the Idaho Health Insurance Exchange
and continues to make a repeal of the Act a legislative and campaign priority.
As background, a health insurance exchange is primarily an Internet-based marketplace where qualified health insurance plans are sold, similar to the way travel websites typically sell airline tickets. In other words, exchanges offer standardized plans and information so customers can make “apples to apples” comparisons between competing health plans.
Exchanges are intended to provide one-stop shopping for qualified health plans and make purchasing health insurance easier and more understandable. Exchanges interactively assist individuals and small businesses by providing pricing and other information necessary to purchase health insurance. Under the ACA, an exchange may utilize agents, brokers and in-person assisters, all of whom assist individuals and families in obtaining health insurance.
The Act set forth certain provisions relating to YHI’s structure and governance. For governance, YHI is governed by a 19-person board, most of who are appointed by the governor. The board includes stakeholders who represent all areas of business, healthcare, insurance and government.
For structure, YHI is an independent body corporate and politic, created by Idaho statute and similar to other entities such as the Idaho Housing and Finance Association. Idaho Code § 41-6104. But YHI is not a state agency. Id. YHI employees are not be state employees, id., and YHI debts are not state debts. Idaho Code § 41-6105. YHI has no power to raise taxes and it is not entitled to funding from the state. Id. Although the establishment of YHI is funded by the federal government, under the ACA, YHI must be self-sufficient by January 1, 2016.
Although not a state agency, an important function of YHI is to direct eligible individuals into a state’s Medicaid system. YHI will verify an individual or family’s income and direct that individual or family to Medicaid if eligibility requirements are met. Recent reports indicate that Idaho’s Medicaid enrollment has surged by almost six percent largely as a result of the implementation of Idaho’s exchange.
For those not eligible for Medicaid, the ACA provides sliding-scale premium subsidies for individuals and families who earn between 100 and 400 percent of the poverty level ($23,850 to $94,200 for a family of four)—a significant portion of Idaho’s residents. But to receive premium subsidies, the private insurance must be purchased on a qualified exchange. As a result, over time, most, if not all, individual insurance will likely eventually be purchased on an exchange. Unfortunately, with Idaho’s reluctance to expand its Medicaid program as contemplated by the ACA, the vast majority of individuals and families who earn less than 100 percent of the federal poverty level are not eligible for any assistance whatsoever.
YHI’s first open enrollment period for individuals and families on Idaho’s exchange ended on March 31. For that initial enrollment period, 76,061 Idahoans obtained health insurance coverage through YHI. Also, over 800 agents and brokers have been trained and certified to sell plans through YHI’s website. In addition to the agents and brokers, YHI has trained and certified approximately 330 in-person assisters (all of whom are from organizations based in Idaho) to help individuals obtain health insurance. These consumer connectors can be found in hospitals, physicians’ offices, public health districts and other places where the uninsured may be seeking health care or other assistance. Finally, during the first open enrollment period, YHI held 153 events statewide, including 14 enrollment open houses.
A primary purpose of the ACA was to help the uninsured obtain health insurance. Despite significant political obstacles, Idaho’s willingness to build a state-based exchange that is controlled by Idahoans has resulted in a significant number of Idaho’s residents obtaining health insurance, many for the first time. Almost universally, business leaders are optimistic that a reduction in the number of uninsured will benefit Idaho’s business community by spreading the costs of health care and health insurance over a broader population and reducing reliance on emergency rooms and other forms of high-cost and belated treatment. How the ACA will impact Idaho in coming years, of course, remains to be seen.
Mr. Mortell is a partner at Hawley Troxell and chairs the firm’s health law practice group. He can be reached at firstname.lastname@example.org. Mr. Hamilton is an attorney in Hawley Troxell’s corporate group and his practice focuses on insurance, health care law, and corporate transactions. He can be reached at email@example.com.