President Trump’s executive order on health care is unlikely to have much impact on Idahoans, according to state Insurance Director Dean Cameron. “My initial read is that honestly, I am somewhat disappointed it didn’t go further,” Cameron said Thursday. “Idahoans are hurting because of the dramatic increases in health care costs year after year, and that warrants some significant re-evalulation and change in the requirements that are put forth by the Affordable Care Act. This doesn’t quite go there.”

You can read our full story here at spokesman.com on the swift, and divided, reaction to the Trump order across the region. Meanwhile, three members of Idaho’s congressional delegation praised the order, with 1st District Rep. Raul Labrador tweeting, “I applaud @realdonaldtrump 4 taking bold action on #healthcare: Greater patient choice will ease pain of #Obamacare.” Further down in this post are full statements from Labrador and Sens. Jim Risch and Mike Crapo.

But Cameron said the main changes envisioned in the order would do little to help curb rate increases in Idaho. Allowing sales of health insurance across state lines likely would have little impact, he said, as plans are based on the physician and hospital contracts they cover – which are place-specific. “It’s not really hard for a carrier to sell in Idaho today,” he said. “We’re really fortunate that we have really five carriers that are selling in the state of Idaho; that’s more than most other states.”

Association health plans also would likely have little impact in the Gem State, he said. “They may be a good idea for some associations … but frankly, we don’t see very many association health plans work that well. … They’re all based on the risks and health conditions of the people in that association.”

So an association full of young, healthy people might offer savings, but one “that’s full of 55-year-old overweight men like me, you’re probably going to get charged higher rates,” Cameron said. “So for some it may help, but it’s not the solution.”

Cameron is more upbeat about Trump’s direction to ease restrictions on short-term health plans, but he noted that the Obama Administration never enforced its limits on those plans under the ACA. “In our state, we’re still selling short-term medical plans for up to 10 months in length.” Nearly 4,000 Idahoans have purchased on those low-cost plans, which may offer limited coverage and exclude pre-existing conditions.

“Overall, I don’t see anything grand that has any dramatic impact that would lower rates for Idahoans,” Cameron said. But he noted that the president and Congress could cut health insurance rates in Idaho by 20 percent simply by funding the cost-sharing reimbursements, or CSR’s. Idaho recently approved rates for next year that show 27 percent increases overall, and 40 percent for silver plans sold on the state insurance exchange.

“We have the hard data – we know what the rates would be,” Cameron said. “If in fact they fund ‘em tomorrow, we’ll change rates for 2018.” Overall rate increases would drop to 7 percent, he said, the increase for silver plans would drop to 20 percent or less. “That’s at a minimum.”

Cameron noted that the federal treasury actually spends much more by not funding the CSRs, because insurers raise rates, which then raises the subsidies that the federal government provides to insurance buyers who meet income guidelines. “It’s far more expensive than paying the CSR,” Cameron said. “What I’m hear from some on the hill is that they’re willing to fund CSRs, but they’re not willing to fund it if we can’t make other changes as well. So you have it being caught in a political battle and the partisan politics at play.”

Cameron, a former longtime GOP state senator, has long opposed the ACA, but he says three changes that fall short of fully repealing the law could dramatically lower rates for Idahoans: Funding the CSRs, giving states increased flexibility to find savings with or without reducing benefits, and funding reinsurance for what’s known as “invisible high-risk pools,” which are invisible to the insurance buyers but provide additional funding to insurers to help cover the health care costs of the most costly patients, such as those with cancer. The ACA repeal bill that passed the House and died dramatically in the Senate this fall included $15 trillion for that reinsurance, Cameron said, of which Idaho’s share would have been $100 million. That alone would have “substantially helped Idahoans,” he said.

“I think it’s foolish for them not to fund the CSRs, and I’ve told all of our delegation that,” Cameron said. “They either need to repeal that or fund it. They’ve been doing this dance where they’ve required it, but they haven’t funded it.”

As a result, the Obama administration funded CSRs one year at a time, Cameron said; the Trump Administration has been funding it month to month and threatening to cut it off. Late Thursday night, the Washington Post reported that the Trump Administration said it will cut off funding for CSRs immediately.

Cameron said he remains a proponent of “repealing or changing or modifying” the ACA. “I don’t care what they do, they’ve just got to make some changes in the way the ACA is operating, because it’s simply killing our citizens pricewise,” he said. “And I’m a fan of giving as much flexibility back to the states. I think if they’d give us the flexibility, we could lower rates dramatically.”

Pat Kelly, executive director of YourHealthIdaho, the state’s insurance exchange, said he agreed with Cameron that the order likely wouldn’t much impact Idahoans, and it doesn’t appear to affect Idahoans on the exchange, at least in the short term – in part because most of the order deals with insurance provided through employers, and the exchange serves only the individual market; anyone who has employer-provided coverage is ineligible.

“It’ll be some time before we’re able to really know what that rulemaking would look like and what the impacts may or may not be in Idaho or on the exchange,” he said. “I wouldn’t expect to see any major changes in 2018.” He added, “We’re going to stay focused on serving Idahoans.”

Here are the full statements from Labrador, Risch and Crapo:

Labrador (on Facebook):

“I applaud President Trump for taking bold action on healthcare today: After the Senate’s failure to act on Obamacare, he signed an executive order making it easier to purchase insurance across state lines through association health plans. While health insurance rates are guaranteed to continue rising under Obamacare, allowing greater patient choice in purchasing plans will help ease the pain. It’s the wisdom of the marketplace: more freedom and more competition leads to lower prices and better quality. That’s why I support fully repealing Obamacare. I will continue advocating for that, while also supporting the president on intermediate-steps like today’s directive.”

Risch:

“I applaud President Trump’s efforts to help small businesses and other individuals who are struggling financially under the Affordable Care Act. I remain committed to repealing and replacing the unworkable, unaffordable law, and this Executive Order is a great early step in providing more insurance options for small businesses. In my role as Chairman of the Senate Small Business Committee, entrepreneurs have overwhelmingly conveyed to me that they are drowning in federal regulations and cannot afford the rising costs of healthcare. The long-overdue actions taken today will finally bring them some relief, by providing small business owners with greater flexibility and more choices for employee health coverage. These are the kinds of ideas we need to spur job growth, kick-start our economy, and help the American people.”

Crapo: