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What CMS Action on Idaho Means for Comprehensive Health Coverage

By Sophia Tripoli,


Yesterday, the Trump administration told insurers and regulators in Idaho that they cannot sell health plans that do not comply with the Affordable Care Act. This is the first recognition from the administration that the ACA remains the law of the land. Despite initiating the process to uphold federal law in Idaho’s individual market, the Trump administration is promoting its own barebones health plans in the proposed rule for short-term plans that was released last month by the Department of Health and Human Services.

Here’s the background on what happened in Idaho.

CMS legal memo to Idaho cites the Affordable Care Act

Yesterday, the Centers for Medicare and Medicaid Services sent Governor Butch Otter and Idaho Department of Insurance Director Dean Cameron a letter stating that Idaho has not substantially enforced provisions of the Affordable Care Act under Insurance Bulletin 18-01, and that HHS has a duty to enforce and uphold the federal law if a state fails to do so. However, Administrator Verma suggested that certain modifications to Idaho’s “state-based plans” could be legally marketed as short-term limited duration coverage under the recent proposed rule, and encouraged Idaho to work with her staff to achieve its policy goals with respect to “state-based plans.”

Since Governor Otter’s executive order and Director Cameron’s Insurance Bulletin 18-01were released earlier this year, Idaho and national health care leaders have been working diligently, urging the Department of Health and Human Services to act, and watching closely to see if Secretary Azar of HHS, and Administrator Verma of CMS would enforce federal law, stopping Idaho’s attempt to allow the sale of health plans that don’t comply with the ACA in their market for people buying health insurance on their own.

Idaho’s proposal would have been devastating for all consumers, explained Families USA in a memo to HHS

Earlier this week, Families USA sent a legal memo to the Department of Health and Human Services stating that the Idaho Insurance Department Bulletin 18-01 allowing the sale of non-ACA compliant “state-based” health insurance plans was unlawful and violated federal law under the Affordable Care Act.

Families USA’s legal analysis stated that by implementing Idaho’s new insurance guidelines, Idaho state officials’ lawless action would have impeded access to high quality, affordable health care for state residents, creating a dangerous precedent for individual market insurance plans to defy federal law, and to allow insurance carriers to deny coverage for consumers based on preexisting conditions.

The effects of Idaho’s proposal would have been devastating for all consumers: Younger, healthier individuals who purchased a non-ACA compliant “state-based plan” would find that when they needed health insurance, their plan lacked essential services, leaving them with high out-of-pocket costs; and sicker, older individuals, left behind in the market with comprehensive coverage needs, would face rising premiums and additional health care costs.

Families USA’s legal memo urged Secretary Azar and Administrator Verma to take action to enforce the Affordable Care Act in Idaho.

Idaho decision does not mean the Trump administration is backing away from weakening consumer protections

With CMS’s legal memo initiating the enforcement of the Affordable Care Act now in the hands of Idaho state officials, Idaho and national leaders may breathe a temporary sigh of relief. But, the work to protect health care for families and children continues.

Despite upholding federal law in Idaho’s individual market, the Trump Administration continues to undermine the Affordable Care Act, threatening access to quality, affordable health care. The Trump Administration’s proposed short-term plan rule would reverse an Obama-era rule on short-term plans, making it legal to sell “short-term insurance plans” for longer periods of time that do not comply with the ACA’s consumer protections.

If the proposed rule for short-term plans was finalized in its current form, it would have similar impacts of Idaho’s proposed insurance guidelines in Bulletin 18-01, except the proposed rule would be the federal law (see our fact sheet on the harm the short-term plan rule would cause). And, given that Administrator Verma has encouraged Idaho to make modifications to their “state-based plan” policy goals to be legally marketed as short-term plans, signals that the Trump administration’s efforts to roll back consumer health care protections has not relented.

Despite the barrage of tactics by the Trump administration to destabilize the Affordable Care Act, national and state leaders must stay steadfast and focused in our fight to protect health care for families and children across the country.