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CMS tells Idaho it must comply with the Affordable Care Act

CMS Administrator Seema Verma suggests Idaho's state-based plans could be modified to be sold as short-term health insurance.

Susan Morse, Senior Editor

Centers for Medicare and Medicaid Services Administrator Seema Verma has told the governor and insurance director of Idaho that they must enforce the Affordable Care Act.

In a March 8 letter, Verma told Idaho Governor Butch Otter and state Department of Insurance Director Dean Cameron, that it was not  CMS's preference to do so, as she believes Idaho has options to implement allowed changes to deal with premium increases and other issues within the state's individual insurance market.

[Also: Blue Cross of Idaho unveils bold plan some say is 'breaking federal law']

Beside premium increases of over 90 percent since 2014, health insurers have incurred over $300 million in losses in the individual market since then, Verma said.

The letter was in response to an executive order issued in January by Idaho Gov. Butch Otter that allowed insurers to start offering state-based plans that didn't comply with the ACA as long as they also offered ACA-compliant plans. 

Under state-based plans, insurers could charge consumers more based on their health status, deny coverage for those with pre-existing conditions and set annual limits on coverage, all of which are not allowed in the ACA. 

Blue Cross of Idaho submitted potential plans to the state.

But Health and Human Services stepped in. Despite an Oct. 12, 2017 executive order by President Trump providing states with flexibility to address the needs of their health insurance markets, HHS made the determination in Idaho that it had to enforce the market requirements of the ACA.

"This administration recognizes and supports the fundamental role states play in regulating insurance," Verma said. "We further recognize that states face unique challenges in repairing the individual health insurance market and we are committed to working with states to provide flexibility to do so. However, the PPACA remains the law and we have a duty to enforce and uphold the law."

Verma suggested that Idaho could modify its state-based plans to legally offer them as short-term, limited-duration plans. 

On February 21, in response to the President Trump's Executive Order, HHS and other departments published a proposed rule that  expanded the availability of short-term, limited-duration health insurance by allowing consumers to buy these plans with health coverage for a period of less than 12 months, rather than the current maximum period of less than three months.

Twitter: @SusanJMorse
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