IN DEPTH: Health insurance in Idaho: What it all costs

Health insurance and health care are a constant topic of discussion in the U.S. and Idaho is no exception.

KIFI/KIDK takes an in-depth look at what it all costs and why.

“Health insurance has been proceeding itself into a death spiral for the last 30 years,” said Mark Semons, owner of Semons Financial Group in Pocatello. “I’ve been doing this for 31 years and its been coming for a long time. But since the implementation of Obamacare, its just stomped the pedal to the floor and it’s been good for a lot of idahoans but it’s not helped the overall situation, which is cost. That is the quintessential problem with healthcare, is the cost.”

Costs for healthcare and health insurance continue to rise each year. Statistics from both the Kaiser Family Foundation and the Centers for Medicaid and Medicare, show that costs in Idaho have steadily been on the rise since the early 90s.

In 1991, Medicaid spent $246 million on health care coverage. But in 2014, those costs sat at $1,540,000,000.

Medicare numbers are similar. In 1991, it paid $324 million, then in 2014, nearly $2.5 billion.

People on those programs in those years also paid more out of pocket.

Combined, people enrolled in those programs paid about $6,500 in personal costs in 1991.

Fast forward to 2014, it’s a combined, out of pocket average cost of nearly $16,000.

Then there’s private healthcare, which is even worse.

“For the first time ever, individual market premiums are higher than group market,” Semons said. “And unless people are getting subsidies through the exchange, more and more they’re choosing to go without.”

Because, in Idaho, under private healthcare, individual cost has more than tripled in the last 20 years.

In 1991, the total spent in Idaho on private health care was $1,778,000,000.

Then in 2014 it jumped to $3,827,000,000.

Now consider Idaho’s average median income. As of 2016, it was $52,249. Lower than other states. But health insurance costs aren’t lower because, Semons said, healthcare doesn’t look at income level.

“Healthcare doesn’t even look at a person’s income,” he explained. “Healthcare costs, if you’re this age, and you want this plan, it will cost you that much. That is set. It’s eligibility for the subsidies that will help you pay for those plans that will vary based on your income and your household size.”

Semons added that cost of living in Idaho, plus the cost of health insurance doesn’t add up for many people.

“Are we still cheaper than California or Washington? Yeah, we are,” Semons said. “But the gap has closed quite a bit. As far as Obamacare is concerned, and the subsidies that are available, Idaho has benefited from that law tremendously. Simply because the subsidies requirements are based on your family size and your income. Because of our cost of living being lower, incomes are respectively lower. So we have a higher percent of our population that qualifies for these subsidies than most states. But the problem is still there. It hasn’t addressed the problem at all. It’s made it worse in many respects.”

Worse, because it’s only put a band-aid on the problem, not a permanent solution, Semons said.

While Idaho’s costs have skyrocketed over the last two decades, there are some economic factors that have gotten health insurance rates to where they currently sit.

“There’s no question that health insurance costs are hitting critical mass stage,” Semons said. “It’s to the point where, unless an employer is paying a good portion of a person’s premium, people simply cannot afford health insurance.”

With private health care costs in the billions, and no significant increase in incomes across the state, more and more Idahoans are saying “no” to health insurance.

Semons said the decline in enrolless is part of what’s huring costs.

“It’s always the healthy people that choose to go without health insurance, which leaves the pool of insured, respectively speaking, getting sicker and sicker and sicker and that’s what’s the big driver in health care. It’s the uninsured population,” explained Semons. “As the uninsured population grows, you have hospitals having to write off more. Well, that causes cost shifting because they have to make their money off of the insured population and it’s just in a death spiral.”

He said social programs like Medicaid and Medicare contribute to the problem also because you have a lot of cost shifting going on there too.

Costs for those programs are geared toward seniors, so they’re meant to be lower, which means once again, hospitals and health care providers drive up their costs elsewhere.

That difference usually falls to the under 65 insured population, another reason premiums go up.

Semons said a third factor is the different plans themselves.

He said there used to be more of a variety, but now most plans are similar.

Because of that, people tend to buy mostly bronze plans. Most deductibles are so high many won’t reach it, so they buy a bronze plan so they can pay a lower premium up front, even if it means they might pay a little more out of pocket later, which can drive up out those out of pocket costs.

Semons said there have been no real improvements to health insurance over the last several years and he doesn’t expect to see it get better any time soon.

“How much we can take? I don’t know,” he said. “A year? Two? Five? I don’t know. I don’t know how much abuse. My sense, though, is its getting closer. It’s getting closer every year.”