Idaho wants to allow insurers to offer plans that do not meet regulations laid out by the Affordable Care Act, or Obamacare.

Experts say the legality of the move is questionable.

Also unclear is whether the Department of Health and Human Services, which has helped undermine Obamacare under President Donald Trump, will step in to prevent the move.



A new health insurance proposal in Idaho is set to test the Trump administration's commitment to allow states to modify — or flat-out ignore — the Affordable Care Act's rules and regulations.

Amid Congress' failure to repeal and replace the ACA, or Obamacare, the Department of Health and Human Services under President Donald Trump has worked unilaterally to undermine many of the law's key elements. The administration has argued the changes are designed to enhance consumer choice and bring down costs.

But a new waiver request from Idaho proposes to go beyond undermining the law and simply ignoring it. It would allow insurers to sell healthcare coverage in the state's marketplace that does not meet Obamacare's requirements to qualify for the exchanges.

It would require that insurers offer some plans that are ACA compliant. But "state-based" plans would not need to meet certain requirements of the law, such as care for 10 basic medical needs that all ACA-compliant plans must cover.

Experts say the "state-based" plans could revert back to pre-ACA rules that allowed insurers charge more for people with a preexisting condition.

"In the Wild West, Idaho is allowing insurers to: Impose preexisting condition exclusions for people who were uninsured. Charge higher premiums for sick people. Exclude certain benefits," tweeted Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan health policy group.

The legality of the move is questionable and could embroil the state in a lengthy court battle.

"I don’t see how this is reconciled with the basic ACA requirements," Scott Harrington, a healthcare management professor at the University of Pennsylvania, told The Wall Street Journal.

It's unclear whether new HHS leadership will challenge the proposed changes. HHS is required to step in and enforce ACA rules if a state does not or can't comply with them, and the department already does so in four states.

Newly confirmed HHS Secretary Alex Azar, whom the Senate confirmed to the position on Wednesday, has a big decision to make, Levitt said.

"If a state is not enforcing the ACA’s insurance rules, the federal government is supposed to step in and do it," he tweeted. "Idaho could be an early challenge for the new HHS Secretary."

But enforcement of the health law would run counter to the actions of the healthcare regulatory structure under Trump in his first year. The HHS and Centers for Medicare and Medicaid Services undertook a series of changes in 2017 that many health policy experts said were targeted at dismantling the ACA.

Tom Price, the previous HHS secretary, laid out a 10-step plan to undermine the law. Price resigned after reports surfaced regarding his overuse of government-funded air travel.

Premiums for a benchmark silver plan in the ACA marketplace for 2018 increased by 37%, more than the year prior, and many insurers cited meddling from Washington as a key reason for the increases.