ACA repeal could cost Idaho $20M per year

BOISE – Indigent care costs in Idaho could jump by more than $20 million per year if the Affordable Care Act is repealed, the administrator of the state’s Catastrophic Health Fund program said Monday.

In a presentation to the House Health and Welfare Committee, Program Director Kathryn Mooney noted that the state’s share of Idaho’s indigent care costs have declined for four straight years, from a record $38.6 million in 2012 to $16.6 million last year.

The overall program costs, including the portion paid by counties, dropped from $55.3 million to $33.9 million during that same time period.

“That’s probably because of the state health exchange,” Mooney said. “Hospitals really took an active role in getting people qualified (for health insurance). If they had any self-pay patients who didn’t have insurance, they ran them through the exchange.”

The exchange was created after Congress approved the Affordable Care Act. Since it began offering subsidized health insurance plans to low- and middle-income Idahoans, the number of new indigent cases has been cut in half, from 1,292 in 2012 to 634 last year.

If Congress repeals the ACA – also known as Obamacare – without putting a replacement plan in place, Mooney said, it would likely reverse the trend of the past four years.

“We anticipate going back to the $50 million (level),” she said. “The reductions we’ve had to this point appear to have all been a result of the health exchange and the ACA.”

The indigent care program is a payer of last resort for Idahoans who can’t otherwise afford medical treatment. If they can’t pay their medical bills within a five-year period, they qualify as medically indigent; in those cases, the local county pays the first $11,000 of any medical bill, with the state picking up the remainder.

The Catastrophic Health Fund has returned more than $40 million to the state general fund since 2012, in part because people who previously relied on indigent care can now afford to buy subsidized insurance.

During a presentation earlier this month, exchange director Pat Kelly noted that Idahoans received about $220 million in federal premium subsidies last year.

If Obamacare is repealed without a replacement, he said, those subsidies would be withdrawn and as many as 87,000 Idahoans could lose their health insurance.

Repealing Obamacare has been a fundamental policy goal for congressional Republicans and incoming President Donald Trump. However, after discussing the issue the past few weeks, the timing of that action has become increasingly uncertain – as has the components of any replacement plan.

Given that uncertainty, the Catastrophic Health Fund has a flat budget request for fiscal 2018. It’s asking for $18 million in state general fund support; the county portion of indigent care costs comes from local property taxes.

In other action Monday, the joint budget committee heard from the Department of Health and Welfare’s Division of Welfare.

Administrator Lori Wolff noted 21 percent of all Idahoans – more than 350,000 people – receive some form of public assistance. That includes 306,000 people who qualify for Medicaid, as well as 181,000 who qualify for food stamps (with some overlap between the two groups).

The division is seeking a $4.5 million, 10.9 percent increase in state general fund support next year. The bulk of that is to upgrade its child support enforcement computer system, which tracks and manages more than $205 million in annual child support payments.

The three-year upgrade project is expected to cost $8 million per year, or $24 million total, with the federal government covering two-thirds of that amount.

The division also is requesting a $975,400 increase in child care support payments. The federal government covers more than 70 percent of the overall cost of the $26 million program, which helps low-income families afford child care services so parents can continue to work or go to school.