CMS Rejects Idaho Proposal for non-Affordable Care Act Plans

The head of President Trump’s Centers for Medicare and Medicaid Services says state efforts to save their individual major markets still have to comply within the Affordable Care Act.

Seema Verma, the CMS administrator, delivered that message in a letter rejecting an Idaho effort to allow the sale of “State-Based Health Benefit Plans,” or limited-benefit major medical plans that allow for medical underwriting.

The ACA “is failing to deliver quality health care options to the American people and has damaged health insurance markets across the nation, including Idaho’s,” Verma writes.

But the ACA “remains the law, and we have a duty to enforce and uphold the law,” Verma writes.

(Related: 5 Hints About the Fate of This Major Medical World)

CMS is the arm of the U.S. Department of Health and Human Services that handles HHS efforts to oversee the ACA rules and programs that affect commercial health insurance.

A copy of Verma’s letter is available here.

The Idaho Proposal

The ACA system now requires issuers of new individual major medical coverage to cover at least about 60% of the value of a standardized essential health benefits (EHB) package, and to cover EHB services without any annual or lifetime benefits caps.

The ACA system forbids issuers from considering personal health factors other than location when deciding whether to issue individual coverage. The ACA prohibits issuers from considering personal health factors other than age, location and tobacco use when pricing new individual coverage.

Idaho proposed, in Bulletin Number 18-01, to let a carrier that offers at least one ACA-compliant plan through the Idaho ACA public exchange sell a non-ACA individual policy outside the exchange system.