Pretending something is true doesn’t make it so. Lt. Gov. Brad Little recently wrote a guest opinion defending January’s executive order on health insurance, titled “The end of Obamacare in Idaho is here.” He hopes his readers believe that Idaho has taken on D.C. Democrats, returning the state to the days before the Affordable Care Act (ACA) became law. This is untrue and covers up a dreadful policy decision.
The truth is that the ACA is law even if Lt. Gov. Little wishes it weren’t. Regardless, the state has directed insurers to begin selling “state-based” health insurance plans that don’t comply with Obamacare’s minimum essential health benefit requirements, something that one legal scholar called “crazy pants illegal.” Less colorful commentators raise similar doubts about the order’s legality. When state law violates federal law, the situation sometimes becomes tricky enough to yield a Supreme Court case. This isn’t one of those cases.
The state’s idea makes sense at first glance: Enable monthly insurance premiums to be less costly so more people can afford coverage on the marketplace. But in health care, there are unavoidable trade-offs. Lower prices mean fewer benefits. Insurers will charge for otherwise free routine preventive care. Pregnancy coverage isn’t required. Also gone are the protections for pre-existing conditions, which prevented insurers from pricing the chronically ill out of health coverage. While those who are insured before selecting one of these “state-based” plans this fall are still protected, anyone without insurance in 2018 isn’t — an important note, since these are the people who this executive order seems intended to help.
An older consumer may be charged up to five times more than a young beneficiary of the same health status, to say nothing of the price difference if the senior isn’t perfectly healthy. These cheaper plans will attract younger and healthier consumers away from ACA-compliant plans, making the latter even more expensive for the sick who need them.
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Instead of wading into legally shady territory — undoubtedly leading to costly court fights — the state should make sure everyone has an affordable insurance option by closing the coverage gap, something Close the Gap and Medicaid for Idaho are working hard to do. This approach leaves in place the important consumer protections of the ACA while helping cover thousands who are currently uninsured. However improbably, Obamacare has survived. As long as it is law we need to help Idahoans while playing by its rules.
Daniel Nelson is from Nampa and is studying medicine at the University of Michigan and public policy at Harvard University. He helps direct policy and health care community outreach at Medicaid for Idaho, an organization seeking to expand Medicaid eligibility through a statewide ballot initiative.