For more than 86,000 Idahoans, health care reform has meant new, affordable options for health coverage, with an average premium, after federal subsidies, of just $65 a month. “Clearly, we offer a service that was needed,” said Pat Kelly, executive director of Your Health Idaho, Idaho’s state insurance exchange. “Eighty-six thousand people in Idaho certainly demonstrates a need for what we do.”

But for another 78,000 Idahoans, health care reform has brought nothing but unfulfilled promises. They make too little to qualify for the subsidized coverage, which was envisioned to serve people making 100-400 percent of the federal poverty level. They make too much to enroll in Idaho’s Medicaid program, which mostly covers children and the disabled. They’re part of a coverage gap that affects residents of states like Idaho that didn’t accept federal funds to expand Medicaid to cover low-income, nondisabled adults.

About 54,000 of those who fall into that coverage gap applied for coverage on Idaho’s state health insurance exchange during last year’s open enrollment, only to be turned away. “It’s pretty telling that people really wanted to get something, and just couldn’t because they were too poor,” said Stephen Weeg, board chairman of Idaho’s exchange and a member of Gov. Butch Otter’s Medicaid task force, which has been calling for Idaho to address the coverage gap for the past three years. In September, a 36-year-old Idaho Falls woman who fell into that gap died of an asthma attack, though earlier, routine treatment could have saved her.

Many Idaho officials remain skeptical that federal subsidies are sustainable. They worry that the state’s historically low insurance prices will become a thing of the past, as insurers face new mandates to cover mental health care and other areas the state never required them to include in their policies in the past.

“We have no confidence that the premium tax credit approach will survive another administration,” said Idaho Department of Insurance Director Dean Cameron, a Republican who co-chaired the Legislature’s budget committee from 2001 to 2015 and worked as an insurance agent before taking the state post this year. “Did the federal government take on more than it can afford?” You can read my full story here from Sunday’s Spokesman-Review on the state of health care reform in Idaho, and see a graphic presentation here on where reform stands in both Washington and Idaho.