State health exchange sees slight drop in ‘18 enrollment


About 4,000 fewer people signed up for insurance through Idaho’s state exchange in 2018 than did for 2017. 

The 2018 enrollment deadline was Dec. 15, and 101,793 people signed up for health insurance through Your Health Idaho for next year, Your Health Idaho officials said in a news release.

This is down from about 106,000 who signed up for 2017, said Pat Kelly, Your Health Idaho’s executive director. This year’s open enrollment period, which is set by the federal Centers for Medicare and Medicaid Services, started Nov. 1 and was half as long as it was for 2017.

“We’re actually pretty pleased with this year’s results,” Kelly said. “Enrollments always fluctuate throughout the year. We had a little over 93,000 customers who were covered throughout 2017. It’s typical to see declines from open enrollments throughout the year.”

The Legislature created Your Health Idaho in 2013, making Idaho the only Republican-run state with its own insurance exchange. Most other red states use the federal marketplace.

President Donald Trump and the Republican-controlled Congress started the year promising to repeal the Affordable Care Act, the law which set up the federal health insurance marketplace and the framework and subsidies for states to set up health insurance exchanges such as Your Health Idaho. Kelly said the number of people who signed up for 2018 despite the political uncertainty is “a testament to Idaho’s model for operating an exchange.”

Your Health Idaho, the state departments of Insurance and Health and Welfare and a statewide group of insurance agents have teamed up to prepare for future federal policy changes, according to the release.

“We know there will be more adjustments to make in our future, and we will continue to provide Idahoans with choice and control over their health insurance coverage in the years to come,” Kelly said.

While more comprehensive repeal efforts have stalled, the Trump administration has succeeded in chipping away at the ACA. As well as halving the enrollment period, it has ended for 2018 the “cost sharing reduction” payments, or subsidies to insurance companies to help cover the cost of insurance for some low-income people. And the “individual mandate,” or the requirement that most people need to have health insurance or face a tax penalty, was repealed as part of the tax cut bill that passed earlier this month.

The mandate repeal doesn’t kick in until 2019. Either way, Kelly doesn’t expect it to have a big impact. He estimated 5 to 7 percent of customers might drop their coverage without the requirement.

“Most of our customers have found there is value to being insured,” he said.

Eliminating the cost-sharing reductions, though, has already had an impact. The average individual rates, which were approved by the Department of Insurance in September, went up 27 percent for 2018, much of it attributable to the impact of the loss of federal funding on the mid-level “silver” plans. However, the premium subsidies mandated by the ACA also increased in response, meaning the difference was mostly covered by the tax credit for many customers.

The average monthly premium for the second-cheapest silver plan for a 35-year-old making $25,600 went from $142 to $143 a month statewide after the tax credit increase, according to a rate comparison the Department of Insurance put out in September. More than 80 percent of people with insurance through the exchange have historically gotten the tax credit.

Statistics on average plan costs and the average subsidies and out-of-pocket increases to customers now that enrollment is closed weren’t immediately available Wednesday. Kelly credited the insurance department with planning for the change in cost sharing reduction funding. The department instructed insurers to offer rate proposals for 2018 assuming the cost sharing reduction funding would be gone, although that wasn’t settled yet when it came up with the rates this summer.

The cost of “silver” plans went up 39 percent on average, leading to a roughly 21 percent drop in the number of people signing up for these, Kelly said, and in tandem a 15 percent increase in the number of people signing up for lower-cost “bronze” plans and a 5-point increase in the number of people signing up for the more comprehensive “gold” plans. The bronze and gold plans went up by an average of 11 percent and 9 percent, respectively.

Seven companies offered plans through the exchange in 2018, one fewer than this year — BridgeSpan left the market. Of the seven, Kelly said they offered 299 plans between them, three making plans available statewide and four just in parts of the state.

Reporter Nathan Brown can be reached at 208-542-6757.