Idaho’s health insurance enrollments are held up — another pandemic domino effect

Without a fully automated system, Idaho’s insurance exchange is several weeks behind on processing applications for 2022 health plans.

By: - January 17, 2022 4:45 am
Screenshot of the Your Health Idaho website

The Your Health Idaho website on Jan. 14 displays an alert to let consumers know it is processing applications. (Screenshot)

Renae Poseley has severe pain in her right hip. Her doctor last year told her to see a specialist, because it seemed that a medical implant in her back was malfunctioning. She likely needs surgery.

Poseley, who lives in Mountain Home, didn’t have insurance for most of 2021. She signed up for a plan through Your Health Idaho — the insurance marketplace established by Idaho under the Affordable Care Act — before the marketplace closed in December. With constant pain, she couldn’t wait to finally book an appointment.

But when the Idaho Capital Sun reached her by phone last week, Poseley was still waiting for word on her application.

“It’s going on two months of me living in this excruciating pain, because I can’t get insurance,” she said.

The problem is, her health insurance is there, just waiting to be claimed. She just couldn’t access it because her application is one of many held up at Your Health Idaho.

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The problem is bigger than just Poseley. According to YourHealthIdaho.org — the exchange’s website — as of Friday, new applications submitted after Dec. 3 have yet to be processed.

About 8% of enrollments were still in the queue as of Friday.

“We created a little bit of a perfect storm,” said Pat Kelly, executive director of the Your Health Idaho insurance exchange.

The perfect storm: offering health insurance during a pandemic, and absorbing the work of another overwhelmed state agency — the Idaho Department of Health and Welfare — at a time when hiring more staff is a challenge.

Waiting for medical care in 2021, and again in 2022

Poseley’s situation is complicated. She had health insurance for a while last year, but the plan she’d selected would not cover medical care through St. Luke’s Health System — which owns the hospital in the community where Poseley lives.

Then, she said, she was approved for disability but has a long waiting period for health coverage. She also had pension income that made her ineligible for Medicaid. So, her only option for insurance was the exchange. She bided her time until Your Health Idaho opened in the fall.

In the meantime, she said, she developed a kidney stone. She waited two months to see a doctor — at which point, the stone was so big, it had to be surgically removed, she said.

Poseley said she has tried to make appointments while her insurance plan is in limbo, but was told she must pay up front.

“I don’t have that kind of money, so I’m sitting here waiting, and waiting, and it’s very frustrating and painful, not only mentally but also physically,” she said. “It’s a severe medical emergency to me. It might not be to anybody else, but it is to me because it hurts.”

Are you waiting for health insurance?

If you’re one of the applicants who hasn’t received health insurance coverage information from Your Health Idaho, you can contact your insurance agent or the exchange at [email protected] for guidance.

Meanwhile, health insurance companies that sell plans on the exchange are aware of the problem, and anyone who applied by the Dec. 22 deadline can use their health insurance, says Your Health Idaho Executive Director Pat Kelly.

But, to do that, they will need to choose a plan without knowing exactly how much of the premium their income-based subsidy will cover.

“Your Health Idaho has worked with the insurance carriers to establish extended grace periods for consumers to pay their monthly premiums,” a YHI spokesperson said in an email. “In the event that the process extends beyond that grace period, there are policies in place to ensure coverage and any applicable tax credits can be backdated, and the consumer will not be without coverage due to processing delays.”

What happens when low unemployment meets a staffing shortage

The exchange “saw unprecedented demand for health insurance this year,” Kelly said. That is partly because of temporary federal aid that put subsidized health insurance in reach of higher income Idahoans and slashed about one-third of the cost for monthly premiums.

“I think, also, we were more effective at getting the word out … and people understand that comprehensive health insurance is a big part of the toolkit as we come out of the pandemic,” Kelly said.

Kelly explained that the Idaho Department of Health and Welfare used to do the behind-the-scenes work of looking at an Idahoan’s application and determining what kind of financial assistance they qualified for: Medicaid coverage, or a premium subsidy for Your Health Idaho plans, or nothing.

Your Health Idaho made a decision to take over that job, for the 2022 enrollment season.

But the “Great Resignation” had other plans. Your Health Idaho couldn’t find enough people to hire.

We are suffering from the same thing other employers are. ... We are having staffing challenges.

– Pat Kelly, executive director, Your Health Idaho

The exchange usually bulks up its staff when it opens for enrollment in the fall. It hires 30% to 40% more people to answer phones, handle customer service issues and help process applications.

Last year, they added “somewhere between about 5% to 10%” more staff, he said. That meant doing much more work, with much fewer people.

The exchange asked Health and Welfare for help managing the flood of applications, “and they have given us what help they can,” Kelly said.

Health and Welfare, though, is dealing with its own staffing challenges and is going into year three of managing Idaho’s pandemic response.

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“We have prided ourselves on delivering exceptional customer service, and to be honest with you, we have failed at that this year,” Kelly said in an interview last week. “We know that our customers deserve better.”

The staff at Your Health Idaho have been working from 6 a.m. to 8 p.m. every day, trying to clear the backlog, he said.

The plan is to “be caught up by the end of the month,” he said. “We are doing absolutely everything we can to do that.”

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Audrey Dutton
Audrey Dutton

Audrey Dutton, senior investigative reporter, joined the Idaho Capital Sun after 10 years at the Idaho Statesman. Her favorite topics to cover include health care, business, consumer protection issues and white collar crime. Dutton hails from Twin Falls. She attended college at Hamline University in St. Paul, Minnesota, and received a master's degree in journalism from Columbia University in New York City. Before coming home to Idaho, Dutton worked as a journalist in Minnesota, New York, Maryland and Washington, D.C. Dutton's work has earned dozens of state, regional and national awards for investigative reporting, health care and business reporting, data visualization and more.

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