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Q&A: Idaho is 'pushing the envelope' with health insurance plan. Can it do that?

Julie Appleby, Kaiser Health News on

Published in Health & Fitness

Secondly, some experts say the argument might include concerns that the state-based plans could pull healthy people out of the ACA market and drive up premiums there.

Cameron expects the effect will be the opposite, helping stabilize those premiums by bringing more healthy people into insurers' risk pools through the state-based plans. Insurers would have to pool their claims from both ACA and state-based plans.

Q: How different are these plans from ACA coverage?

A: Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms, said they are "in the middle in terms of the consumer protections they provide, but they're not as good as the ACA."

They're better than some non-ACA compliant alternatives already on the market, such as limited-benefit plans, which can be really skimpy -- paying paltry amounts or nothing at all toward hospital care or drugs, for example.

By contrast, Idaho's directive says the new plans must cover outpatient services, emergency care, hospitalization, mental health and substance abuse treatment, drugs, rehabilitation, lab services and preventive care. Insurers must include maternity coverage in at least one state-based plan.

 

"Setting aside the question of whether a state can do this, it would not be a radical change," said Haislmaier at Heritage.

But, unlike ACA plans, the state plans could cap coverage at $1 million annually. They could charge older people up to five times more than younger ones (the ACA limits the ratio to 3-to-1) and sick people could be charged up to 50 percent more for premiums than standard rates. On the flip side, very healthy people could have rates of up to 50 percent below standard rates.

On pre-existing conditions -- which is among the ACA's most popular provisions -- the Idaho rules would require insurers to accept people with medical problems, but they could exclude coverage for those specific conditions if the person were uninsured within 63 days of the new plan taking effect.

Still, Cameron argues that the rules of the Idaho plan -- in practice -- would not be much different than what people face now.

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