Idaho's Republican Gov. Butch Otter could give the current occupant of the Oval Office a run for his money when it comes to completely misunderstanding policy. On Friday, Otter signed an executive order ostensibly designed to cover the Medicaid gap—the people who make too much to qualify for the state's extremely stingy Medicaid rules, but not enough to purchase health insurance on the state's health exchange, set up under the Affordable Care Act. In doing so, Otter set the state up for a costly potential legal fight that it would be pretty much ensured to lose. Otter's order would allow insurers in the state to sell health plans that don't meet the federal law's coverage requirements.
While details are still being worked out, officials said that under the order insurers might not have to cover all of ObamaCare’s essential health benefits, which include areas like maternity care and mental health coverage.
State officials said they are trying to move forward with the changes on their own without any action from Washington, seeking to give people cheaper options. However, some have raised questions about whether that is legal.
Because he's kind of dim, and is surrounded by equally dim advisors, he believes that the repeal of the individual mandate in the law that was included in the tax bill allows him to do this. "Congress and President Trump have eliminated the individual mandate requiring all Americans to buy Obamacare plans or face financial penalties," Otter said. Yes that part is true. But then he said this. "That means we will no longer be penalized for buying coverage that doesn't meet all the Obamacare rules." Which, no. The rules for essential health benefits are still in place. The mandate had nothing to do with that.
Tim Jost, a law professor at Washington and Lee University, said he doubted Idaho’s action would be legal.
"States can't say we've decided we're not going to follow the federal law anymore," Jost said. "We tried that in the 1860s and it didn't work."
The blunder left the state's director of the department of insurance, Dean Cameron, trying to clean up the mess. He explained that he was not preparing for major changes to the essential health benefits but that "most of the essential health benefits if not all of them." Yeah. No. States can't kind of comply with federal law, picking and choosing the parts they like.
Otter's effort points to one thing—the gap is a big issue in Idaho, and will be a big issue in November when his lieutenant governor, Brad Little, tries to win the big seat. The whole event, in fact, could be seen as less making health policy than an effort to put Little ahead of the pack on the issue. He joined Otter in signing the executive order and will be accompanying Otter on a tour around the state to talk about the new plan. But really it's to campaign.
The focus on health care, though, will do one very good thing—it will raise the profile of Medicaid for Idaho, a ballot initiative to really close the coverage gap by putting Medicaid expansion up for a popular vote, as Maine did last fall. The group is already gathering signatures to get the initiative on the ballot, with a formal kick-off scheduled Saturday, January 13. "When you look at the possible solutions to close the coverage gap, Medicaid Expansion is a no-brainer," the group's leader Luke Mayville said in a press release. "Since the legislature hasn't passed it, we decided to give Idahoans the chance to vote on it." Idahoans will be hearing a lot about the issue, particularly if it ends up in court. That makes the job for signature gatherers that much easier.