Plenty of Republicans at every level of government have devoted a lot of time and energy to formulating creative strategies to repeal, amend, circumvent, or sabotage the Affordable Care Act. But led by its governor, Butch Otter, the state of Idaho has come up with a new gambit that’s either bold or just laughable: ignoring the law.
Earlier this month, in response to complaints about rising health insurance premiums and as an alternative to Medicaid expansion, Otter signed an executive order instructing his state insurance agency to let insurers issue individual policies that did not comply with ACA requirements for essential health benefits or nondiscrimination on the basis of age or preexisting conditions. Now, said agency has made it official: Insurers can offer barebones policies that violate all sorts of Obamacare provisions, including price discrimination against sick people and caps on pay-outs.
The state’s rationalization seems to be that anything goes now that Congress has repealed the Obamacare individual purchasing mandate. But Idaho’s approach is an open invitation to younger and healthier people to leave the Obamacare insurance pool, plunging it into the kind of “death spiral” reformers have always feared. And it’s “wildly illegal,” in the words of Sam Berger of the Center for American Progress.
The two big questions now are whether the Trump administration (led in this area by new HHS Secretary Alex Azar) chooses to enforce a law it does not support, and whether insurers risk the legal liability involved in taking Idaho up on its offer. They could be subject to fines of $100 per customer per day for failure to comply with the law; that would add up into a crushing burden pretty soon.
So far the administration has refused to comment on Idaho’s gambit. Perhaps there’s some quiet jawboning going on behind the scenes to avoid embarrassment for everybody. But if Azar chooses to turn a blind eye and let Idaho violate the law, other GOP-governed states will probably soon follow, and we could soon see the de facto repeal of the Affordable Care Act in parts of the country.