Task Force Highlights Big Questions Idaho Faces On Health Care Reform

Emilie Ritter Saunders / StateImpact

The Legislature''s health care task force is meeting in Boise today.

The Legislature’s health care task force donned its waders this morning.  It was time to take up the many questions surrounding the extent to which Idaho will implement President Obama’s Affordable Care Act.

StateImpact has followed closely the implications of the Supreme Court’s landmark ruling upholding the health care law.  For states — especially those where opposition to the law runs high — the ruling raised two main questions: Will the state establish its own health insurance exchange, and will it decide to expand Medicaid eligibility as prescribed under the ACA?

Let’s take it question by question, and break down the highlights from today’s discussion.  First, the health insurance exchange.  (Remember, this is the so-called online marketplace that will allow consumers to view their health insurance options by costs and benefits.)

• We still don’t know what a federal exchange implemented in Idaho would look like, Joy Wilson of the National Conference of State Legislatures confirmed.
• The state must establish the minimum essential benefits that must be offered by participating insurers by September 30. That’s a deadline the Idaho Department of Insurance is prepared to meet.
• The next opportunity for the state to apply for a federal grant to help cover the costs to establish the exchange is in November.
• There is a possibility of establishing an exchange that’s a federal-state partnership.  Under such a partnership, the federal government might oversee the website and answering service center, Department of Insurance Director Bill Deal said, while the state oversees plan management.
• Each November, states will have an opportunity to declare their intent to change their health insurance exchange plan.  Many states are considering the federal-state partnership as a way to get their exchanges up and running, Director Deal said.

Now, the Medicaid expansion.  As StateImpact has explained in past coverage, the Supreme Court’s ruling in effect gives states a choice about whether to expand their Medicaid programs.  The federal government would initially cover 100 percent of the cost of expansion, phased down to 90 percent by 2020.

• It’s not clear what the Medicaid expansion would mean for the state budget, Department of Health and Welfare Director Richard Armstrong confirmed.  The state has consultants looking into that question.
• A key concern is what’s called “woodworking.”  Idaho has historically had a large number of people who are Medicaid-eligible, but who are not enrolled.  If an adult enrolls in Medicaid under the expanded program, and that person has children, the children will also automatically be enrolled.  Because those children would have been eligible in absence of the expansion, the federal-state cost split will be 70-30 for their coverage.
• If the state opts into the expansion, the Department of Health and Welfare can establish a distinct and basic benefit plan for those who become eligible. Director Armstrong says the department intends to do that.

The overarching question about all of this is how the state will arrive at a course of action.  Gov. C.L. “Butch” Otter has established two working groups, which begin meeting later this week.  By all accounts, he does not intend to convene a special session of the Legislature.  Given that many decisions must be made before legislators come back to town in January, it is left to Gov. Otter to make a “non-binding declaration,” as Department of Insurance Director Deal termed it.

That line of questioning eventually led Sen. Dan Schmidt (D-Moscow) to ask Brian Kane, the Assistant Chief Deputy of the Idaho Attorney General’s Office, this question:  What happens if the governor and the legislature are at odds?

“That would be a really legally interesting situation,” Kane said, pausing for emphasis.  “I don’t know that there’s an answer to that at this point.”