Idaho has a chance to pass its own plan to cover uninsured Idahoans, control costs

Idaho Statesman Editorial Board

Idaho State Capitol in Boise.
Idaho State Capitol in Boise. kgreen@idahostatesman.com

It’s a cliché that success in politics takes time and teamwork, but that makes it no less true. Ideas often take multiple legislative sessions to get properly vetted, to get more lawmakers familiar with the need and the shape of the solution, to evolve into a form that can win passage.

So it is that Idaho is finally poised to take a big step in addressing three important needs in our state health care and insurance system: Covering more people who don’t have and can’t afford health insurance; slowing the overall rise in health insurance costs; and reducing unreimbursed and indigent care that falls to county and state governments, that gets written off as bad debt and that drives too many people into personal bankruptcy.

Idaho can do these good things and more with House Bill 464, a bill on its way to the House floor after passing the House Health and Welfare Committee last week.

The Idaho Health Care Plan would offer coverage to as many as 35,000 people in Idaho’s “gap population,” estimated this winter at between 51,000 and 62,000. It reflects leadership by the governor and his Health and Welfare Department and good work by Idaho advocates. It’s a good example of lawmaking: It’s a plan that gets us closer to covering all Idahoans while keeping control and authorship in our state. Experience is the best teacher and Idaho will learn much as it undertakes its own plan.

It does this by working with the federal government to seek two waivers to existing law. One waiver would offer more tax credits under the Affordable Care Act, using federal dollars to allow Idahoans to buy insurance at discounted rates. Because of a quirk in the ACA, low-income Idahoans who make too much to qualify for Medicaid but not enough to qualify for subsidies buying insurance are left in the gap. The waiver, if approved by the feds, would help well over half of those Idahoans buy insurance.

Another waiver to the Social Security Act would aid a small, critical group of people: As many as 3,500 Idahoans with complex, high-cost health problems would move out of the private health care market and into managed care under Medicaid. Such a move could make the remaining pool of Idahoans easier and cheaper to insure, reducing overall premiums by as much as 20 percent.

Even if the Legislature passes the bill, the waivers will still need federal sign off. But officials have encouraged states to try such experiments, and there’s every reason to think Idaho’s proposals would be well received.

This plan has the broad appeal of helping all of Idahoans, not just those in the gap and not just those who get government assistance or subsidies. By covering uninsured Idahoans and caring carefully for the highest-cost individuals, the overall system becomes less risky and, therefore, less expensive to insure. This can actually put further downward pressure on rising rates for everyone.

The state’s match – $29 million – is modest, while taking advantage of federal dollars available to expand health insurance coverage, funds to which Idahoans are contributing with their federal taxes.

Expanding coverage will let people get care up front rather than wait for urgent and emergency care that is more expensive for them and for the system. Best of all are the benefits that come from keeping people healthy or helping them bounce back from mental and physical illness, able to work and care for their families. The plan is a win for the neediest Idahoans, a win for individuals and companies who purchase health care in Idaho, and a win for the leaders who demonstrate that Idaho can work together to do right by its citizens.

Unsigned editorials represent the opinion of the Statesman editorial board.