Idaho insurance rates are heading up. But wait! Congress may do something about that.

Idaho’s health exchange insurance rates are expected to rise by double digits in 2018, propelled by the pressure of uncertainty in Washington as Republicans fight a key Obamacare program. If the federal government waits until after Nov. 1 — the start of open enrollment — to make a decision on the program, it could cause a serious headache for Idaho.

The Idaho Department of Insurance on Friday unveiled the final rate increases for health plans sold under the Affordable Care Act.

The rate hikes average 27 percent. They are driven mostly by skyrocketing “silver” plan premiums — slated to rise by 40 percent, while “bronze” and “gold” plans increase just 8 percent and 9 percent.

“The rate increases, in particular on silver-level plans, are definitely greater than we would like,” said Idaho Department of Insurance Director Dean Cameron. “There is legitimate uncertainty” regarding whether the government will continue to pay for certain subsidies for low-income users of the exchange.

Why silver matters

Those “silver” plans are pivotal, for two reasons:

Reason 1: They’re the only Obamacare plans that offer a special benefit for low-income people — a subsidy that helps cover out-of-pocket costs such as copays. The subsidy isn’t cheap to provide; it costs about $7 billion.

From the launch of Obamacare till now, the federal government paid for them. But congressional Republicans are fighting to stop that, and the Trump administration has not promised to continue paying after this month.

Without a guarantee that the subsidies won’t fall on insurers’ shoulders next year, insurance companies are setting their rates sky-high to make sure they can afford the new expense. Meanwhile, the health care industry is calling on Congress to make a long-term commitment to the payments.

(Regardless of what happens, if you qualify for the cost-sharing benefit, you won’t notice a change. You’ll still get the benefit, it will just come from a different place.)

Reason 2: “Silver” plans also play a huge role in determining how much premium assistance people get for all health plans sold on exchanges. If a certain silver plan is suddenly 40 percent more expensive, people will get a lot more federal assistance when they buy a health exchange plan. And that could make a “gold” plan more affordable, when its higher premium used to put it out of reach for a lot of people.

That’s where things could get tricky.

Right now, insurers are planning for the worst — that the federal government will cut off subsidies.

But if federal lawmakers end up committing to the subsidies, that would drastically change how much insurers need to charge for premiums.

The rates that insurers are slated to charge for “silver” plans next year would be cut by more than 20 percent if subsidies are continued, according to the Idaho Department of Insurance. And that would affect how much actual help consumers would get to pay for those pricey “gold” plans.

Countdown to Nov. 1

The next two weeks are critical, because the Idaho insurance exchange opens for business Nov. 1 — and that’s when people start choosing which plan they want and can afford.

If Congress makes a commitment by mid-October, the exchange and Idaho’s insurance regulators will have enough time to make sure everything’s in order by launch day. “We’re able to switch to a different set of plans ... and we can do that relatively quickly,” said Your Health Idaho executive director Pat Kelly.

If Congress waits until November or December to make a commitment, insurers, regulators and the exchange will have to hustle to make changes. And those changes would come midstream while people are signing up for health insurance. “For the consumer, it could get confusing,” Kelly said.

What if Congress waits until next year to commit — when 2018 health insurance plans are already in effect? Nobody really knows what would happen. Kelly said it would be “exponentially more complicated.”

Could people who chose a “gold” plan thinking they’d get more premium assistance be able to switch to a cheaper one? Would people continue paying higher premiums the whole year, or would premiums be lowered? Would insurers issue refunds?

Kelly said the Your Health Idaho exchange and the Idaho departments of Health and Welfare and Insurance are working closely to prepare for any action in Washington.

“Your Health Idaho has been awfully nimble in the past, and we’re ready to be nimble again,” he said.

It’s also possible that a decision will be made to end the subsidies forever. That would set in motion a different set of options for health insurers and the government.

While things in Washington are still up in the air, insurance experts have one recommendation for Obamacare customers: seek free advice from a licensed insurance agent.

“This year, it’s more critical than ever,” Kelly said of working with agents. “People need to find the plan that works best for them, understanding that things may change. And that, I think, is the message we have been imparting in the agent and broker training.”

This story was originally published September 29, 2017 at 5:42 PM with the headline "Idaho insurance rates are heading up. But wait! Congress may do something about that.."