As congressional Republicans race to dismantle the Affordable Care Act, tens of thousands of Idahoans remain unsure about what could happen to their own insurance coverage and Your Health Idaho—touted as one of the most efficient health care exchanges in the country.
The ACA, a.k.a. Obamacare, still requires Americans to sign up for health insurance and offers federal subsidies to offset costs. Since the law passed in 2010, nearly 20 million Americans have secured health coverage. In Idaho, to date, more than 100,000 people are insured through the ACA.
President Donald Trump and the Republican-dominated Congress have all promised to "repeal and replace" Obamacare as soon as possible, but any hasty repeal without a replacement could be costly. The Washington, D.C.-based Center on Budget and Policy Priorities estimates the number of uninsured Idahoans could double to 366,000 by 2019. Meanwhile, the Congressional Budget Office estimates a repeal could double by 2026.
Your Health Idaho Executive Director Pat Kelly said 87 percent of residents enrolled through Your Health Idaho currently receive a tax credit, but if Obamacare is fully repealed without a replacement, that assistance could disappear, further limiting access to health insurance.
Uncertainty over the fate of the ACA was reflected in a recent Boise State University survey, which showed approximately 70 percent of respondents said health care should be a chief concern for the Idaho Legislature. More than half said they favored keeping the state health insurance exchange, Your Health Idaho.
"What's going to happen to the people who all of a sudden don't have health care?" asked Christine Simon, an Idahoan in favor of Obamacare. "Three million Americans feel like they're not being represented if it gets repealed."
On his first day in office, Trump issued an executive order that would make it easier to roll back parts of the ACA—including penalties for Americans who don't purchase insurance. The deadline to sign up for a 2017 insurance plans is Tuesday, Jan. 31.
Among state exchanges, Your Health Idaho stands apart. The exchange has the highest per capita enrollment in the nation and is on track to reach record participation for 2017 with more than 100,000 enrollees. While most state exchanges are losing providers in the coming year, Your Health Idaho has more providers and more options in 2017 than in previous years.
In a 2016 analysis, health care consulting group Leavitt Partners highlighted Your Health Idaho as "lean" and "efficient" among state exchanges. The analysts noted Your Health Idaho operates on a $9 million budget, compared to the $63 million median cost of other exchanges.
Kelly said "change is coming," but added he's focused on serving Idahoans until that change—whatever it might be—needs to be made.
"We remain focused on the business at hand," he said. "If any changes are implemented, we will work closely with the governor's office and other Idaho policymakers to determine how best to serve Idahoans."
Andy Booth is one of those Idahoans who would struggle following a repeal of the ACA.
For years, Booth said he got by without health insurance, counting himself lucky that he never had a serious accident on his bike. He has insurance for the first time under Obamacare.
"As it is, it's beneficial to pay into the system," Booth said. "It's kind of painful to pay, but at least if I get hit by a car I have a little bit of coverage."
If his premiums go up or his tax credit gets removed, Booth said he won't be able to swing the payments.
"It'll be like a car payment—and I can't even afford a car," he said.
Wayne Hoffman, president of conservative think tank the Idaho Freedom Foundation, thinks consumers would be better off with less government control of insurance.
"Instead of saving up money and being able to afford to purchase health care, [consumers are] spending every month on an insurance product that they can't use," said Hoffman. "Ultimately, the conversation should be about how to provide health care that's low cost, accessible and patient- driven."
People like Jill Mason think the government could do more.
Mason is one of an estimated 78,000 Idahoans who fall in the so-called Medicaid "coverage gap." She doesn't make enough money to qualify for Obamacare, but also doesn't qualify for Medicaid. An expansion of Medicaid would close the gap, but Idaho remains one of 19 states that have opted not to do so.
Mason tries to avoid going to the doctor, but couldn't help it when she hurt her knee last June. The doctor wanted to take X-rays but Mason declined, due to the cost. The trip still cost her nearly $200.
"They say that the uninsured are disinclined to seek treatment, and that's why," Mason said. "It's too expensive."
Jim Dobbins, who recently renewed his Your Health Idaho coverage despite uncertainty about its future, likens Obamacare to a piece of public infrastructure.
"As an able bodied male, [insurance] costs me more now, but I get that. We're all in this together," he said. "It's like roads: We can all be resentful that we pay for roads that we don't use, but the fact that we have these roads is what makes the economy run."