By Susannah Luthi | March 8, 2018
The Trump administration will not let Idaho proceed with its plan
to offer insurance that doesn't comply with the Affordable Care Act's coverage
mandates.
In a letter to Idaho Republican Gov. Butch Otter and state Insurance Director Dean Cameron Thursday, CMS Administrator Seema Verma said the agency has "reason to believe" the state would not be "substantially enforcing" current law by allowing these plans on the exchanges.
Should state insurers sell the plans anyway, the CMS could impose civil monetary penalties followed by a cease-and-desist order, Verma wrote.
"If any issuer does not comply with the cease-and-desist letter by, for example, selling non-compliant plans in the state, CMS, as the primary enforcer, could initiate an investigation of the potential violation and based on the outcome, could impose a civil money penalty for each violation of up to $100 each day, for each responsible entity, for each individual affected by the violation," Verma wrote.
Cameron had told Modern Healthcare that state officials hoped the administration's interpretation of this "substantial enforcement" would allow them to sell the plans. Blue Cross of Idaho was the first of the state's carriers to unveil plans that don't comply with all the ACA's essential health benefits.
Verma praised the state's "dedication to the people of Idaho and your efforts to address the damage caused by the PPACA," but stated that the agency must uphold the law.
This is the second consecutive blow to Idaho officials who had planned a two-pronged effort to lower premiums in the state's individual market. Just last week, the state Legislature spiked a bill that would approve an application for a dual 1115-1332 waiver to move chronically ill patients to Medicaid and set up a reinsurance pool for the exchanges.
Blue Cross introduced the plans in response to Otter's early January executive order that asked for "creative" options to expand choice on the exchanges. Cameron later that month issued guidelines for the new "state-based plans" that would allow insurers in the state to get out of some ACA rules as long as they offered ACA-compliant plans as well.
Story developing …
In a letter to Idaho Republican Gov. Butch Otter and state Insurance Director Dean Cameron Thursday, CMS Administrator Seema Verma said the agency has "reason to believe" the state would not be "substantially enforcing" current law by allowing these plans on the exchanges.
Should state insurers sell the plans anyway, the CMS could impose civil monetary penalties followed by a cease-and-desist order, Verma wrote.
"If any issuer does not comply with the cease-and-desist letter by, for example, selling non-compliant plans in the state, CMS, as the primary enforcer, could initiate an investigation of the potential violation and based on the outcome, could impose a civil money penalty for each violation of up to $100 each day, for each responsible entity, for each individual affected by the violation," Verma wrote.
Cameron had told Modern Healthcare that state officials hoped the administration's interpretation of this "substantial enforcement" would allow them to sell the plans. Blue Cross of Idaho was the first of the state's carriers to unveil plans that don't comply with all the ACA's essential health benefits.
Verma praised the state's "dedication to the people of Idaho and your efforts to address the damage caused by the PPACA," but stated that the agency must uphold the law.
This is the second consecutive blow to Idaho officials who had planned a two-pronged effort to lower premiums in the state's individual market. Just last week, the state Legislature spiked a bill that would approve an application for a dual 1115-1332 waiver to move chronically ill patients to Medicaid and set up a reinsurance pool for the exchanges.
Blue Cross introduced the plans in response to Otter's early January executive order that asked for "creative" options to expand choice on the exchanges. Cameron later that month issued guidelines for the new "state-based plans" that would allow insurers in the state to get out of some ACA rules as long as they offered ACA-compliant plans as well.
Story developing …
Susannah Luthi covers health policy and politics
in Congress for Modern Healthcare. Most recently, Luthi covered health reform
and the Affordable Care Act exchanges for Inside Health Policy. She returned to
journalism from a stint abroad exporting vanilla in Polynesia. She has a
bachelor’s degree in Classics and journalism from Hillsdale College in Michigan
and a master’s in professional writing from the University of Southern
California.
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