Robert Ehlert: Too much trusting, too little verifying

rehlert@idahostatesman.comDecember 8, 2013 

Almost eight months ago a group of 19 Idaho business, insurance and health care volunteers began meeting to create what today is known as Your Health Idaho, the Gem State expression of the health care reforms.

The group was commissioned by Gov. Butch Otter to create from virtually thin air a structure for Idaho to carry out the federal mandate of the Patient Protection and Affordable Care Act of 2010 - aka Obamacare.

After debate in the Idaho Legislature earlier this year, Idaho elected to forgo allowing the federal government to run its exchange in favor of creating a more customized and Idaho-friendly marketplace.

The idea — a good one at the time — was to make the best of a federal health care mandate by taking control of the parts Idaho could influence, such as create its own structure, a marketplace, choosing the insurance companies developing a website. Among the advantages was, and is, that Idaho established a lower "assesment fee" — 1.5 percent instead of the federal rate of 3 percent.

What appeared a nearly impossible task in late April was met with great enthusiasm by the 19-member Idaho Health Exchange Board, headed by Stephen Weeg.

But now I wonder if the task was more impossible than first imagined.

Too often the Idaho effort found itself moving at a frantic pace. States like California began working on an exchange back in 2011. Idaho jumped into the cauldron with just five months to cobble together a plan.

Federal officials made themselves available and were present at the board's initial meeting in April. Other Northwest states had blazed organizational trails that Idaho borrowed from. Working hard over the summer, the exchange board collaborated with the Idaho Department of Insurance and the exchange's new executive director, Amy Dowd, to hammer out a plan that resulted in four health and four dental plans with 146 individual options — 61 individual health plans, 55 small business health plans and 30 dental options.

Dutiful as the board was, it invested largely in the trust and advice it was receiving from the feds — people like Susan Johnson, regional director of the U.S. Department of Health & Human Services. But it was the kind of trust that originated a dozen layers above Johnson on the bureaucratic ladder that, in retrospect, no one completely verified.

There were templates for websites and a focus on marketing plans. All of those things were fine, until they started unraveling. Unintended consequences would be revealed later — like canceled policies that President Obama had said consumers would be able to keep.

Late in the game, Weeg made the call to abandon plans for a full-service customized Idaho website in favor of the generic federal one.

On Oct. 1, and over the past several weeks as exchanges activated, it became obvious that states with the federal website were going to go down with the mother ship because healthcare.org was a mess.

"It was like getting all ready, getting in the car, and it won't start," said Weeg.

Though healthcare.org has undergone a redesign — and President Obama has been telling everybody the site is much improved — the states using it don't have much to show for it.

Dowd said Your Health Idaho has 338 Idahoans signed up with a health insurance plan. Some 4,753 Idahoans have completed applications, and supposedly are "shopping." Weeg says the December numbers will be known in January. He and Dowd both say they hear that enrollees are having an easier time.

For good or bad, Idaho is stuck with the federal website through the open enrollment that ends March 31. Weeg expects to announce soon the name of a new website vendor. That should create further distance from the troubles associated with using the federal tools, but I wonder what the ultimate cost will be to health care reform success.

This is a hindsight comment, aimed at Obama, Otter, the Legislature and anybody who considers the validity of federal promises about humungous entitlement programs in the future: Idaho bit off too much in the time allotted, was in too much of a hurry and, as a result, trusted too heavily in government templates, forecasts and technology.

Obama's promise that people could keep their old health insurance policies in the ACA era is a promise that only insurance companies can make good.

There was too much trust, not enough verification.

Otter and Idaho need to wrest back as much control as possible of our health care management, the sooner the better. On Jan. 1, 2016, Your health Idaho must sink or swim on its own with its own funding. The good news is the Idaho Health Exchange board seems up to the task.

Robert Ehlert is the Statesman's editorial page editor.

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