The Road To Idaho's Health Insurance Exchange

Idaho's state-run health insurance exchange is expected to begin enrollment by Oct. 1, 2013 and fully functional by Jan. 1, 2014. The exchange is an online marketplace where Idahoans will be able to shop for and purchase health insurance. The Idaho Legislature approved plans to build the exchange in March 2013, but two years of intense debate preceded the vote.

After the U.S. Supreme Court upheld the Obama Administration's federal health care overhaul in 2012, two key decisions rested with states. One, should states expand Medicaid to include more people? Two, should states create their own health insurance exchanges?

Gov. C.L. "Butch" Otter chose not to make a snap judgement, instead, he created a work group to study whether Idaho should create it's own health insurance exchange, let the federal government create one for the state, or some combination of the two options.

Otter's 14-member panel decided in October 2012 that Idaho should move forward with creating it's own exchange. The governor followed suit, and Gov. Otter issued a statement on Dec. 11, 2012 that Idaho should create a state-based exchange.

Two Years Of Debate

The health insurance exchange debate has been ongoing ever since it became clear an exchange would be part of the federal health care reform package which was signed into law in 2010.

Because Idaho didn't have the framework set up for a health insurance exchange, it was expected to be one of the biggest debates of the 2012 legislative session

The Associated Press held a special discussion of the issue during its January 2012 legislative preview. In a series of interviews that StateImpact conducted in December, legislator after legislator predicted it would be a defining issue of the months ahead.

Instead, it was more or less dead on arrival. Not even a plan developed by Sen. Dean Cameron (R-Rupert) and Rep. Fred Wood (R-Burley) for a stripped-down, state-run exchange could muster sufficient support.

Health insurance exchanges are a primary component of the Affordable Care Act. By their most basic description, exchanges are organizations — essentially online marketplaces — intended to make health insurance options more clear and, thereby, more competitive.

The underlying logic is this: individuals and small businesses don’t have perfect information or a great deal of bargaining power with insurers.  A health insurance exchange lays out the private and public health insurance options, explaining plans in terms of benefits and costs.

Under the Affordable Care Act, states can create their own exchanges or wait for the federal government to do it for them.

Rep. Wood says it was ideological opposition to the health care law that did in the prospects for a state-run exchange.  “I think there was a certain number of people that simply didn’t want anything to do with an exchange,” he said.  “And they were in a position that they could affect that outcome. In other words: no exchange.”

Wood, a retired physician and former director of the Cassia Regional Medical Center, believes state lawmakers are rolling the dice, hoping the federal health care law will be overturned.  “They’re betting that the Supreme Court will strike down the entire law,” he said. “And if we bet the wrong way, it could be very costly for the state.”

Costly because states creating their own exchanges will have some discretion to set the essential benefits that must be provided by insurers. But states falling under the federal plan likely won’t have that same flexibility. The Idaho Department of Insurance has predicted Idaho employers could expect to pay millions more in health care costs under a federal exchange.

Medical, Health Care
Emilie Ritter Saunders / Boise State Public Radio

Your Health Idaho's executive director says nearly 74,000 Idahoans have selected a health insurance plan on the state-based exchange.

Pat Kelly told exchange board members Tuesday that the number fell somewhere mid-range of the exchange's projections.

However, Kelly did not say how many of those enrolled for the first time. He also didn't mention how many people had submitted an application but had not yet selected a health plan.

Last year, roughly 76,000 people signed up on Idaho's exchange.

insurance exchange, computer, your health idaho
Emilie Ritter Saunders / Boise State Public Radio

Idaho officials say the state-based health insurance marketplace had nearly 13,000 visitors just days after it opened for business.

Your Health Idaho Executive Director Pat Kelly isn't immediately releasing how many Idahoans signed up for coverage on the state exchange's website. However, he told reporters Monday yourhealthidaho.org hasn't experienced any of the technical glitches that plagued the federal marketplace last year since it launched Saturday.

Last year, 76,000 Idaho residents enrolled within six months.

Stethescope, Health Care, Doctor, Medical
Emilie Ritter Saunders / Boise State Public Radio

Idaho is on track to become the only Republican-dominated state to launch its own health insurance exchange when enrollment opens Nov. 15.

But the state exchange is facing pressure to function just as well as the federal exchange when it first opened for enrollment last year.

While the federal exchange's website experienced serious glitches when it first launched, it quickly outperformed other state exchanges in the following weeks. States like Oregon chose to rely on the federal government's site because it was too costly and time-consuming to fix their own.

census.gov

The percentage of Idahoans with no health insurance was unchanged between 2012 and 2013. A new report from the U.S. Census Bureau says 16.2 percent of the state’s residents lacked health coverage in 2013. That’s about 257,000 people.

The nation as a whole saw a slight decline in the uninsured in that time, from 14.8 percent in 2012 to 14.5 percent in 2013.

Amy Dowd
Samantha Wright / Boise State Public Radio

New Mexico's health insurance exchange is hiring an Idaho official to run the online marketplace as it prepares for the next round of enrollment.

The exchange's board of director voted Friday to select Amy Dowd as its chief executive officer. Dowd has been executive director of Idaho's insurance exchange since last year.

The board is finalizing a contract with Dowd and it's uncertain when she will start her new job.

Interim CEO Mike Nunez has been running New Mexico's exchange since it was created last year.

Butch Otter
Emilie Ritter Saunders / Boise State Public Radio

Idaho Gov. C.L. “Butch” Otter says no matter what, the Affordable Care Act, or Obamacare as it's known, was coming to Idaho.  

“Because if we hadn’t [have] established our own state exchange, we would have had Obamacare in Idaho,” he says. “We didn’t have a choice. We were going to have an exchange in Idaho. We were going to have the Obamacare exchange in Idaho or we were gonna have [an]  Idaho exchange in Idaho.”

Emilie Ritter Saunders / Boise State Public Radio

Russ Fulcher says incumbent Gov. C.L. “Butch” Otter no longer represents the heart of Idaho's Republican Party.  

Fulcher, a state senator from Meridian, has been on the campaign trail since late November spreading that message. He’s the tea party candidate trying to unseat a longtime cowboy politician he says has a political “machine” behind him.

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Emilie Ritter Saunders / Boise State Public Radio

Idaho's health insurance exchange announced Monday that more than 76,000 Idahoans have signed up for coverage through the new online marketplace created through the Affordable Care Act, or Obamacare. 

“We are very, very pleased with the outcomes for our six months of the launch of Your Health Idaho,” said Executive Director Amy Dowd.

Dowd says the Congressional Budget Office wanted to have 40,000 Idahoans sign up through the exchange during the first six-month open-enrollment period. Your Health Idaho exceeded that target by more than 36,000 people.

You only have until the end of this month to sign up for coverage using one of the new health insurance exchanges.

The U.S. Department of Health and Human Services says nearly 44,000 Idahoans have selected a health insurance plan on Your Health Idaho.

The agency says Idaho remains second in the nation per capita for the number of people selecting plans on the exchange.

The latest numbers show a 33 percent increase from one month ago.

The enrollment period ends on March 31.

The latest figures on who's signing up under the federal health care law tell a surprising story about one of the most conservative states in the country.

Idaho's insurance exchange voted to give two companies publicly funded contracts worth $40.8 million to build and operate a state enrollment system due to replace the federal software in place now.

Your Health Idaho's board Friday voted to give the work to GetInsured and Accenture, the two companies that also built California's state insurance exchange.

Idaho has used the federal government's exchange for the past five months because it didn't have enough time to build its own system before the Oct. 1, 2013 deadline.

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Emilie Ritter Saunders / Boise State Public Radio

Sign-ups in Idaho's insurance exchange accelerated in January, rising to 32,899 as more people sought health care coverage as the March 31 enrollment deadline approaches.

The federal government reported Wednesday Your Health Idaho enrollment amounted to the second-highest per capita in the country, with only Vermont's numbers topping those of the Gem State.

Exchange spokeswoman Jody Olson said the figures are positive, but urged residents currently without insurance to seek coverage required under President Barack Obama's 2010 health care overhaul.

Idaho insurance exchange officials don't know if the 20,000 people signed up for coverage effective Jan. 1 come from the ranks of the uninsured, or if they previously had insurance but switched to exchange policies because they're now eligible for financial assistance.

Your Health Idaho board chairman Stephen Weeg and director Amy Dowd gave their first report to the Idaho Legislature yesterday.

Afterward, Weeg and Dowd acknowledged nobody is collecting that information about those getting coverage.

Idaho health insurance exchange officials say 19,922 people have bought insurance plans from the newly-created online marketplace. Nearly a third of those who purchased policies are between 55-and 64-years old. YourHealthIdaho.org is the portal Idaho set up to meet the requirements of the Affordable Care Act or Obamacare.

Enrollment in Idaho's insurance exchange has blossomed after the federal government fixed the website that residents use to sign up for health insurance coverage.

Roughly 20,000 people signed up for individual and family coverage in time for it to begin Jan. 1.

That's up from 1,730 people who purchased coverage available via Your Health Idaho through Nov. 30.

The new total was announced Friday by Your Health Idaho spokeswoman Jody Olson.

Idaho Capitol, statehouse
Samantha Wright / Boise State Public Radio

The 2014 Idaho Legislature kicks off Monday with Gov. C.L. "Butch" Otter’s annual State of the State speech. 

Lawmakers will look at a variety of issues this year, from the budget to education, all through the lens of primary elections, which come up in May.

Boise State University Political Science professor Gary Moncrief says lawmakers will look closely at a couple of issues: healthcare and education.

Idaho's insurance exchange will begin paid marketing around Dec. 20, a delay of more than a month.

Still, don't expect to see Your Health Idaho television advertising over Christmas.

Consultants told the exchange's board Thursday holiday TV spots were too expensive, so this initial "bridge" marketing will concentrate instead on radio, Internet and newspapers.

The exchange's $3 million-plus ad campaign has been pushed back due to software problems since Oct. 1.

Stethescope, Health Care, Doctor, Medical
Emilie Ritter Saunders / Boise State Public Radio

While the number of Idahoans who've signed up for subsidized health plans through the state's insurance exchange increased in November, enrollment hasn't made much of a dent in the number of uninsured people in Idaho.

“The number of individuals who have selected a marketplace plan and are considered enrolled through the process is 1,730 as of November 30,” says insurance exchange director Amy Dowd.

That's a big jump from the 338 people who signed up for a plan in October, the first month the online marketplace was available to consumers.

medical, stethoscope
Jasleen_Kaur / Flickr Creative Commons

Enrollment in Idaho's insurance exchange accelerated in November as the federal government raced to fix software problems that had hampered operations during the first month.

In all, 1,730 people have purchased health care plans available through YourHealthIdaho.org through Nov. 30.

The figure, announced Wednesday, was about five times the 338 people who managed to select plans during the exchange's first month.

The numbers in Idaho are similar to the national trend.

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