Idaho lawmakers tee up bill to reform prior authorization, and more health insurance issues

A panel of Idaho lawmakers that studied issues in the health insurance market on Wednesday formalized plans to develop legislation to address a range of issues that affect access to health care.

The Idaho Health Insurers Working Group voted to tee up plans to reform prior authorization, a cost-control measure that health insurers use to deny covering certain treatments, and to target several other issues that the interim legislative committee heard about in its meetings in the last few months and through surveys it sent to insurers and health care providers.

In a series of votes, the interim committee teed up a series of bills focused on health insurance that could be considered by the Legislature when it returns next January. Some of the other bills that could be drafted could address:

• Reducing delayed payments to providers, by setting standards for providers and insurers;
• Establishing uniform standards to credential health care providers through insurers; and
• Requiring the Idaho Department of Insurance, which regulates health insurers, to collect and present to the Legislature data about the timeliness of payments, and healthcare denial rates. That might also include information on one arbitration tool created by Congress that the state’s largest insurer, Blue Cross of Idaho, claims that a North Idaho microhospital heavily relies upon. Blue Cross argues the practice could drive up the cost of healthcare, and Congress is considering overhauling the tool.

The potential prior authorization reform bill wouldn’t be the Legislature’s first attempt to address the issue, which some patients say can delay access to healthcare through drawn out timelines to issue decisions. Earlier this year, a bill, House Bill 611, set out to require more transparency and establish timelines in the process, but it never received a committee hearing. 

Prior authorization also impacts healthcare providers. Providers in Idaho reported spending more time on administrative work to respond to prior authorization requests in recent years, according to data that committee co-chairman Rep. Dustin Manwaring, R-Pocatello, summarized. In 2025, an American Medical Association survey found that 92% of physicians reported negative patient impacts caused by prior authorization processes. 

The committee was formed after a now-resolved contract fallout between a hospital in East Idaho, Portneuf Medical Center, and the insurer that runs the health plan for state employees, Regence BlueShield of Idaho. 

In the coming years, the state plans to transition Medicaid, a health insurance public assistance program for people who have disabilities or earn low-incomes, from being state-run to being managed by private health insurance companies.