Blue Cross of Idaho to sell ‘enhanced short term’ health insurance - Twin Falls Times-News
BOISE — Blue Cross of Idaho is gearing up to be the first company to offer a new kind of health insurance in Idaho. And an insurer based in Utah could be next.
The new insurance plans are called “enhanced short term” plans. They are similar to the “state based plans” that Idaho Gov. Brad Little was unable to get approved by federal regulators. Most notably, they don’t comply with the Affordable Care Act. The Trump administration paved the way for them in rules issued last year — but not without a fight over whether they undermine the ACA, also known as Obamacare.
The new plans Blue Cross expects to roll out Dec. 1 are aimed at the 125,000 Idahoans who are middle class and uninsured, self-employed or make too much money to qualify for subsidies to pay for Your Health Idaho plans.
The company thinks about 35,000 people will buy the plans over the next three years.
“I run into rancher after farmer after independent business person who just looks at me, pleading, ‘When are we going to have something we can afford again?’ ” said Peter Sorensen, vice president of individual and government markets at Blue Cross of Idaho.
The rollout comes two weeks before the deadline to buy ACA-compliant insurance plans on Idaho’s exchange.
WHAT DO THESE INSURANCE PLANS GIVE YOU?Blue Cross’s new Access plans are designed to cost less than what Idahoans can buy on Your Health Idaho, the state insurance exchange. The company provided the Idaho Statesman with some examples:
A person who lives in Ada County, is 39 years old, doesn’t use tobacco and has no medical conditions or prescriptions, would pay between $207 and $329 a month for the Access plans. The Statesman found that same person would pay $331 to $554 a month for Blue Cross plans sold on the exchange.
A 50-year-old Ada County couple with no tobacco use, but one person who has hypertension and needs a prescription drug, would pay $608 to $1,020 for the new Blue Cross plans. They would pay $937 to $1,568 per month for Blue Cross plans on the exchange.
Those lower premiums come with a downside for some people. They have coverage limits — the Blue Cross plans stop paying at $2 million in a year. They’re not as generous in some ways as the exchange plans. The premiums are based on a person’s health, so sicker people will pay more because of their health conditions. And Blue Cross can deny coverage for pre-existing conditions, including pregnancy, in some situations.
“There is a 12-month waiting period for the treatment of pre-existing conditions that have occurred or been treated within six months of the start date of the plan,” according to Blue Cross of Idaho. “A person with creditable health coverage (most types of health insurance) in the last year can shorten or eliminate that waiting period.”
And because they don’t comply with the Affordable Care Act, the “enhanced short term” plans cannot be subsidized. So, for people who qualify for income-based premium subsidies and copay assistance, the new plans could actually be more expensive.
But for people who are generally healthy, and whose incomes are too high for subsidized insurance, Blue Cross expects the plans to be a welcome relief.
The plans also include perks the company isn’t yet offering in its exchange plans. For example, taking a child to the doctor for any reason would be covered with zero out-of-pocket costs.
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ARE THESE JUNK INSURANCE?Analysts and consumer advocates have criticized non-ACA compliant plans, labeling them “junk insurance.” Obamacare made certain consumer protections a basic part of health insurance — no denial of pre-existing conditions, preventive care with no copays, women paying the same premiums as men, sick and healthy people paying the same premiums, no cap on coverage when people have catastrophic health problems, and others.
The new Idaho plans don’t guarantee all of those protections. But Idaho’s top insurance regulator says they’re not the “junk” critics have dubbed the Trump-approved health insurance plans.
“Some of the narrative coming out of D.C., and others, are still caught in the old-style short term plans designed to be coverage for people between jobs,” said Idaho Department of Insurance Director Dean Cameron. “(These are) much more significant than those and much more significant in benefits. They are closer to the ACA approach. So, we’re hopeful that will help us stabilize our market, but time will tell as we monitor it.”
Idaho’s exchange plans, like those around the country, have become more expensive over the years. There are a few reasons for that — one being a shift in the insurance pool as sick people enroll and healthy people drop out.
The Trump administration’s dismantling since 2017 of a tax penalty for not having ACA-compliant health insurance both helped bring about the new “enhanced short term” plans and exacerbated the shift that was driving up premiums. Researchers from The Commonwealth Fund in 2018 said getting rid of the penalty would drive up insurance rates by 1% to 13%.
Cameron says he hopes the new plans will bring back a balance.
“The rates had gone up to the point where people who were healthy were dropping out ... or finding other ways to pay for their care,” like health care sharing ministries that are not insurance, he said.
Cameron called the zero copay for children’s outpatient care “a tremendous feature” for families struggling to pay for children’s medical care. And he said the plans, for some adults, will cover more than the lowest-priced plans on the Idaho exchange.
Does that mean Idaho is giving up on its effort to create “state based” plans that are similar in many ways to the new “enhanced short term” plans?
Cameron says no.
“We still may pursue the state-based plans,” he said. “We still are having conversations with (the Centers for Medicare and Medicaid Services) on that approach, although we have certainly spent more of our time — and I think the carriers have spent more of their time — on the door that is at least partially open, rather than battling the one that seems to be mostly closed.”
Cameron said he thinks other companies will jump into the pool after Blue Cross. One of them is Utah-based insurer SelectHealth.
SelectHealth filed paperwork this fall to start offering the “enhanced short term” plans. The company would not say when it plans to start selling them, or provide much detail to the Statesman beyond what its insurance filings say.
A SelectHealth spokeswoman told the Statesman Monday, “It’s important that consumers understand that these plans are different than the ACA plans available through (Your Health Idaho). We encourage people to call SelectHealth or their agent for assistance in choosing a plan that best meets their individual needs.”
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