Obamacare’s Own Private Idaho

While the nation remains transfixed by the deep state skullduggery employed to install Hillary Clinton in the White House, a quiet revolution has been gathering steam in flyover country. The latest skirmish was fought on February 7, when the Idaho House Health and Welfare Committee voted to send Governor Butch Otter’s less restrictive alteration to Obamacare to the full Idaho House of Representatives. The opening salvo took the form of a January executive order from Otter requiring the state’s Department of Insurance to examine all options for making health coverage affordable for Idahoans, whether or not they complied with Obamacare:

I, C.L. “BUTCH” OTTER, Governor of the State of Idaho, by virtue of the authority vested in me under the Constitution and laws of the State of Idaho do hereby… Direct the Idaho Department of Insurance to approve options that follow all State-based requirements, even if not all PPACA requirements are met…

It goes without saying that the phrase concerning the requirements of PPACA (a.k.a. Obamacare) immediately incurred the wrath of Obamacare apologists everywhere. The Idaho Statesman characterized the governor’s action as a “rogue move” and predictably produced an “expert” willing to declare it beyond the bounds of the law. The paper quoted Nicholas Bagley, a University of Michigan law professor, who tweeted this scholarly opinion: “These Idaho guidelines for health insurers are crazypants illegal. It’s not even close.” All of this studiously ignores President Trump’s October EO inviting the states to do just what Idaho is doing.

That executive order specifically encouraged officials of the executive branch of the federal government to work with the states to “expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance.” Obviously, neither Idaho nor any other state can simply ignore federal law. They may, however, apply for Section 1332 and 1115 waivers. The “Idaho Health Care Plan” would involve one such application, the goal of which is to free Idahoans caught in a coverage trap because they earn too much money to qualify for Medicaid, but not quite enough to qualify for subsidized coverage. The draft waiver puts it thus:

Idaho estimates that 78,000 Idaho residents have incomes of under 100% FPL and are without health coverage. Due to the requirement to have income of at least 100% FPL in order to qualify for assistance in paying for monthly insurance premiums (APTC), these Idahoans are effectively locked out of the commercial health insurance market due to the unaffordability of coverage. While these working U.S. citizens are ineligible for APTC, lawfully-present aliens falling into the same income range are eligible for and receive APTC.

Let me repeat that last sentence, “While these working U.S. citizens are ineligible for APTC, lawfully-present aliens falling into the same income range are eligible for and receive APTC.” It gives the lie to claims by Obamacare apologists that immigrants aren’t afforded more and better benefits from “reform” than are actual citizens of the U.S. These aren’t illegal aliens, but there is no standard of equitability that justifies providing any alien with better health benefits than working Americans. The Spokesman Review highlights the real cost of such perverse rules by quoting Jessica Rachels, who testified before the Health and Welfare Committee:

My husband is self-employed, and we’re both in the coverage gap.… I am a full-time caregiver for my daughter who uses a wheelchair, and my father, who also has a disability.… For our family of seven, it’s a choice between a $100 doctor’s visit or buying groceries.

Idaho is also applying for a Section 1115 Medicaid Waiver. This waiver would add a new eligibility category: the Complex Medical Needs program. This change in the state’s Medicaid program would allow — not force — an estimated 2,000 to 3,000 adults with serious and costly diseases to move from expensive plans they must now purchase via the exchanges to Medicaid. Idaho is not an expansion state, so the patients in question are not the able-bodied adults that Obamacare has herded into Medicaid in Democrat-run states. This waiver would be a win-win for very sick patients and the government. As the draft waiver describes it:

Moving them to the Complex Medical Needs program will reduce the amount of APTC and CSRs paid by the federal government, which will instead pay the Federal Medical Assistance Percentage (FMAP) of 71.17% for 2018. Additionally, the premium rates for individual health insurance plans are anticipated to substantially decrease due to a number of these individuals with chronic and costly medical conditions no longer being a part of the individual risk pool.

Obamacare apologists tell us there is a simple solution to Idaho’s problems — Medicaid expansion. That claim is debunked by the fiscal disaster John Kasich created in Ohio by expanding the program. If Idaho’s 1332 and 1115 waivers are approved, however, tens of thousands of patients will escape the coverage gap, and many very ill patients will be able access coverage at a lower cost. This combination will decrease premiums and save the government money. It won’t lead to a completely private Idaho. But, if successful, it will be duplicated in other states and Obamacare will eventually be buried underground like a wild potato.

David Catron
David Catron
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David Catron is a health care consultant and frequent contributor to The American Spectator. You can follow him on Twitter at @Catronicus.
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