Idaho Helps Murder Obamacare With Illegal Fuck-You Plans Penalizing Pre-Existing Conditions.
Almost literally, in the case of health insurance
Back in January, Idaho Gov. Butch Otter signed an executive order that would allow the Idaho Department of Insurance (DOI) to approve private health insurance plans that ignore some of the insurance requirements set by the Affordable Care Act under the assumption that while Obamacare is still the law, the Trump administration is likely to look the other way. Under the new rules, the Idaho Statesman explains, insurers can:
- carve out benefits, like maternity coverage. However, any insurer offering state-based plans must have at least one with maternity, which includes prenatal care.
- restore co-pays for preventive care, such as colonoscopies.
- limit annual claims to $1 million, at which point those high-cost patients would be moved onto ACA-compliant plans sold through Idaho’s health insurance exchange.
- deny coverage for pre-existing conditions, to a limited degree.
In maybe the biggest change, a person can end up paying higher premiums because of a history or high risk of expensive medical conditions. In order to get the state-based plans, people can be required to fill out a questionnaire that asks about past health care claims, disorders and treatment[.]
This is exactly what Yr Editrix has been warning would happen since the Trump War On Obamacare began, by the way, SHE WANTS IT KNOWN.
The DOI regs wouldn't allow lifetime caps on medical expenses (yet) and unlike the Bad Old Days, denials of coverage for a pre-existing condition wouldn't be permanent (yet): A denial would only apply to people who had been uninsured for 63 days in the previous year. And the block on coverage could only apply for a single plan year, so the next year a person could get coverage. But as we note, the rules DO allow insurers to charge more, forever, for those with pre-existing conditions, and to charge men less than women since they wouldn't have to be covered for all those icky ladyparts problems or maternity care.
Otter's executive order is a nice little gift to the campaign of Lt. Gov. Brad Little, who's already busy bragging that the order has "ended Obamacare" in Idaho:
By ending Obamacare for many Idahoans we are restoring choice and affordability back into the healthcare marketplace. It’s unfortunate but not surprising that congressional democrats disagree with a majority of Idahoans. #idpol #idleg #idgop LINK: https://t.co/Cp4qFo8DwO pic.twitter.com/Aq3XMNa3k8— Brad Little (@LtGovBradLittle) January 31, 2018
The "state-based" plans will be sold on the Idaho insurance exchange alongside ACA-compliant plans, and in fact could only be sold by companies that also offer regular ACA plans. The rules apply only to individually purchased insurance, not to plans provided by employers.
Wouldn't you know it, Blue Cross of Idaho, which lobbied much of last year for the executive order, submitted five new plans to the Department of Insurance that meet the new "state-based" rules. If approved, they could go on the market as soon as March. Dean Cameron, the director of DOI, couldn't be happier:
We’re excited that they’ve filed [...] Obviously, we’re going to review their application carefully and review their rate carefully to make sure they meet our state guidelines, but we’re excited for Idaho consumers, because now they’ll be given a choice.
But what about the minor detail that all this appears to be a clear violation not just of the spirit, but of the letter of the ACA law? Nicholas Bagley, a professor of law at University of Michigan, tweeted shortly after DOI issued the new regulations,
Yr Wonkette is all in favor of more legal scholars using the phrase "crazypants illegal." And yes, the whataboutists immediately jumped in to say OH YEA WELL WHAT ABOUT SANCTUARY STATES SMART GUY YOU LIBERALS AR MORANS (sanctuary cities/states still comply with federal law; they choose not to use local law enforcement to assist ICE -- and that's perfectly legal). Somewhat more thinky types wondered if this would be a matter of enforcement priorities, like with states that have legal weed, which may be a closer analogy, though not exact, since the ACA has very specific provisions about what insurers can and can't do. And Vox's Sarah Kliff asked what's certain to become a very pertinent question: If the ACA-dismantling dickweeds at HHS don't intervene, would any other party have standing to sue? Bagley said prolly without going into detail.
Now, Mr. Cameron at Idaho DOI doesn't seem especially concerned that newly confirmed HHS secretary Alex Azar is going to come down hard on Idaho for violating a little federal law that Azar's own department is bent on dismantling anyway. Specifically, Cameron explained in an interview earlier this month, "PFFFFT!"
We’ve had lots of discussion about the legality, the rules and the statutes. And we believe we are within our full authority and ability, and we believe we are complying with the provisions. We have had legal discussions with multiple attorneys, both inside the Department of Insurance and outside; multiple discussions with the (Idaho) Attorney General’s Office and certainly with our (deputy attorneys general assigned to the DOI), with the governor’s attorney, with any legal counsel we could run it through, including those who participate and represent entities on Capitol Hill.”
Cameron also said he'd discussed Idaho's desire for "flexibility" with Azar's predecessor at HHS, Tom Price, who was "aware we were considering or trying to get flexibility" (or at least that's what it sounded like over the sound of partying in Price's chartered jet). Cameron added that since the new rules were announced in late January, "we haven’t had any pushback." On the other hand, Azar told the Idaho Statesman for its story yesterday on BCI's new plans,
I’m not aware that our opinions or views have been solicited. There are rules, and there’s a rule of law that we need to enforce.
So that sounds like he's just gonna crack down hard, doesn't it. If he actually thinks to look at...SQUIRREL!
The "state-based" plans BCI wants to sell are pretty similar to their ACA-compliant plans, but with considerably lower premiums in exchange for far higher out-of-pocket costs to consumers:
patients would have to pay thousands of dollars more for care before insurance would fully cover their costs. The out-of-pocket maximums in the sample plan are far higher for prescription drugs as well. Those changes combined could more than double a patient’s responsibility for total medical costs.
There's also that million-dollar annual cap; if someone reaches it, they'd be shifted into an ACA-compliant plan with a higher premium. Blue Cross has decided -- for this first group of plans at least -- to offer plans that cover all the essential health benefits required by ACA-compliant plans, except for one $5500-deductible plan that will not cover maternity benefits. While the new regulations allow insurers to charge a copay for preventive services, BCI is playing it safe and offering them with no copay. For now.
And now that one insurer has jumped in with non-ACA-compliant insurance, get ready for others to follow suit, and for other states to pursue similar schemes if the federal government doesn't show any interest in stopping them. Finally, America can have the glorious two-tier insurance scheme it deserves, where healthy people will pay very little and older, sicker people will pay through the nose or lose coverage altogether. It's an exciting day to be alive, at least if you're in perfect health and can guarantee you'll never age, get sick, be in an accident, or have a baby with a congenital illness.
Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.