Several years back, the Affordable Care Act (ACA) brought a lot of changes to Idaho’s health insurance marketplace. Now, new federal
legislation is being discussed that may bring more changes. The American Health Care Act (AHCA) is a bill, recently passed by the U.S. House
of Representatives, that is intended to “repeal and replace” some of the changes made by the ACA. Many times the discussion about health
insurance reform is driven by mistaken information or misconceptions about current Idaho laws and federal regulations. While the bill is
not yet law, the Department would be happy to answer questions by providing the facts on the current provisions of the AHCA and on health
insurance reform in general. Below are the questions the Department has received and answered so far. Clicking on the question will show
the Department’s response. If your question about health insurance or potential reforms is not on the list, submit it to the
Department using the link below the questions.
Can Idahoans afford for the Affordable Care Act to remain unchanged?
Every Idaho insurance carrier has lost, and continues to lose, millions of dollars in the individual health insurance market. These losses translate
into much higher premium increases for Idahoans, higher out-of-pocket costs, reduced availability of health plans, and narrower provider networks.
The individual insurance market simply is not sustainable as it now stands, and, if left unchanged, may force carriers out of our market.
Will preexisting conditions no longer be covered under the proposed Affordable Care Act replacement?
The proposed replacement, the American Health Care Act, does not change the federal requirement that health insurance plans must cover pre-existing
health conditions for everyone enrolled in the plan. Carriers cannot deny enrollment due to pre-existing conditions. All plans would continue to
be guaranteed issue and guaranteed renewable.
Will premiums increase with the repeal and replacement of the Affordable Care Act?
While the future cannot be predicted with certainty, the likelihood is that health insurance premium amounts charged by insurance carriers
would decrease if the Affordable Care Act is repealed and replaced. Prior to the Affordable Care Act, Idaho had some of the least expensive health
insurance plans in the U.S., and, after a repeal, should once again have lower-cost plans. The proposed replacement plan includes tax credits that
increase with age to help with paying premiums; however lowering the overall premiums charged is of paramount importance.
Under the proposed American Health Care Act, can children born with health problems be denied coverage?
Idaho insurance law requires that newborn children, regardless of health condition, must be placed on their biological or adoptive parents’
health insurance from the moment of birth. Any and all health conditions experienced by the newborn must be covered.
Will Idahoans lose coverage with the repeal and replacement of the Affordable Care Act?
Under the proposed American Health Care Act (AHCA), health insurance plans would continue to be guaranteed issue and
guaranteed renewable, which means no one can be denied coverage or terminated if the premium is paid on time. Idahoans
would continue to have the opportunity to enroll in health insurance coverage through an annual open enrollment period.
Those who experience certain life changes, such as a job change or loss of previous coverage, would continue to be able
to enroll outside the open enrollment period.
Will premium rates for older or less-healthy citizens increase because of the repeal and replacement of Obamacare?
Under the current Affordable Care Act (Obamacare) rules, the oldest individuals enrolled in health insurance plans cannot
be charged premiums that are more than three times higher than the premiums charged for the youngest adults. The proposed
American Health Care Act (AHCA) gives states the option of allowing insurance carriers to charge the oldest enrollees
premiums up to five times greater than those charged for the youngest enrollees. However, the AHCA also provides tax
credits that increase with age, which would offer additional assistance to help older individuals pay premiums.
The AHCA prohibits insurance companies from charging less-healthy individuals more unless a state submits and receives a
waiver to allow health status rating.
Will Idahoans who do not have health insurance coverage be subject to a tax penalty in future years?
Concerning tax year 2017, the IRS is currently reviewing an Executive Order which directs government agencies to ease any
burdens imposed by the ACA – at this point it appears individuals would continue to be subject to a tax penalty when
filing their 2017 tax returns if there is a gap in coverage. Therefore, the best course of action is for Idahoans to
maintain continuous health insurance coverage. The proposed American Health Care Act (AHCA) does not include the
“individual mandate” provision of the Affordable Care Act (ACA), which subjects some uninsured individuals to a
monetary penalty at the time they file their federal income tax returns. However, the AHCA provides for a 30% surcharge
on the monthly premiums of those individuals who enroll in coverage after being previously uninsured.
Do you have a question about Health Insurance?
Submit your questions – our experts will respond with the facts.