The Trump administration health officials said that they ultimately had to make sure the law is enforced as long as it’s on the books. | Olivier Douliery/Pool/Getty Images Trump officials tell Idaho it can’t dump Obamacare

The Trump administration today threw cold water on Idaho's plan to ignore key Obamacare requirements, telling the red state that it must follow the health care law.

Idaho was moving to let insurers offer plans that don’t meet the Affordable Care Act’s robust coverage rules — including protections for pre-existing conditions and mandated benefits — in a bid to expand the availability of cheaper health plans. The Idaho plan has sparked considerable interest from other red states that have long opposed Obamacare.


But Trump administration health officials, who’ve worked to unwind Obamacare through regulation and have encouraged states to pursue alternative coverage options, said that they ultimately had to make sure the law is enforced while it’s on the books.

“CMS is committed to working with states to give them as much flexibility as permissible under the law to provide their citizens the best possible access to healthcare. However, the Affordable Care Act remains the law," read a statement from the Centers for Medicare and Medicaid Services, which oversees the law's insurance marketplaces.

The decision comes after newly installed Health and Human Services Secretary Alex Azar faced pressure for weeks from patient groups and other insurers to reject the Idaho plan. The groups argued it would destabilize the state's insurance marketplace and undermine key protections for people with serious medical conditions. Azar, who served as HHS’ top lawyer during the George W. Bush administration, had demurred for weeks on whether he would let the proposal move ahead.

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Under Obamacare, states are the primary enforcers of the law's private insurance rules, but the federal government is required to step in if a state chooses to not do so. Many legal experts saw the Idaho plan as a clear violation of the law that HHS, despite its opposition to Obamacare, couldn't allow.

Blue Cross of Idaho three weeks ago introduced five health plans under the proposed coverage scheme that it hoped to begin selling next month. State officials and Blue Cross argued that their proposal passes legal muster, contending that Idaho would still be substantially enforcing the 2010 health care law and HHS didn't need to step in.

Idaho officials said they heard from “dozens” of states about their proposal, but no other states have put forward a similar plan yet.

Federal health officials instead encouraged Idaho to take up the administration’s recent move to expand the availability of short-term, limited duration plans. These plans are exempt from many of Obamacare’s coverage rules, but critics deride them as “junk insurance” that cherry pick healthy customers and offer extremely limited coverage.

The administration proposed regulation to expand these plans, but it is still awaiting public feedback before moving ahead. Idaho officials have also suggested the short-term plans weren't an acceptable substitute for the state's proposal.

"I don't know that we see that as being a real good avenue for us," Idaho Insurance Director Dean Cameron said in an interview last week. "What we're trying to do is improve the market."

Idaho Gov. Butch Otter's office declined comment Thursday evening.

Democrats cheered the Trump administration's decision, but they still criticized other actions HHS has taken in recent months to weaken the law.

"Make no mistake, however, while this is the right decision, the Administration continues its many efforts to undermine the law and chip away at its protections, including by encouraging Idaho to sell junk plans in another way," said Rep. Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee.

