After contract dispute with East Idaho hospital, Legislature’s task force to study health insurers

After a major health insurer dropped an East Idaho hospital from its network, Idaho Republican legislative leaders founded a new working group of state lawmakers tasked with studying the practices of health insurance companies.

The formation of the taskforce, formally called the Idaho Health Insurers Working Group, came partly in response to lawmakers’ concerns over the contract dispute fallout, said House Speaker Mike Moyle, one of the highest-ranking Republican lawmakers. Half of the eight-member task force are from East Idaho. 

But it’s also in response to statewide concerns, said Rep. Soñia Galaviz, the sole Democrat appointed to the task force. 

“I too am hearing concerns about health insurance and being denied claims or particular bureaucratic struggles, just a lot of hoops to jump through when you’re trying to get prior authorization or a claim approved, or particular tensions with any given provider or hospital,” the Boise Democrat said. “And so the concerns go beyond Eastern Idaho.”

In an interview on Friday, Moyle said that he and Senate President Pro Tempore Kelly Anthon founded the task force a couple weeks ago. Its first meeting is slated for Aug. 11, with no time or agenda set yet. 

In the weeks leading up to the shakeup in East Idaho health care coverage, the insurer, Regence, argued the for-profit owners of the hospital, Portneuf Regional Medical Center, was asking for an unreasonable pay increase. But the hospital said Regence denied the vast majority of its claims, the Idaho Capital Sun previously reported. Regence runs Idaho’s state employee health insurance plan, covering more than 20,000 state employees and their family members. 

What will the task force focus on?

The website for the new task force lays out an ambitious mission, saying it is charged with studying “the performance of health insurers in Idaho, but not limited to their rates of claim denial and yield on expected reimbursement to providers, delays in treatment caused by prior authorization decisions and related practices, and the amount insurers owe to providers in accepted but unpaid claims,” along with studying “the effect of poor health insurer performance on the health of Idahoans” and making recommendations to the Legislature “on policy solutions to poor health insurer performance.”

But Moyle outlined an even bolder vision: A broad look at addressing health care affordability, including an understanding of how different actors, including medical providers, contribute to costly care for patients. 

“What I’ve learned in politics: A lot of time we jump to conclusions. We think it’s one thing, and then we do our homework and find out, ‘Oh my goodness, we were wrong. It was something different.’ And that I think may be the case with this,” Moyle said in an interview. 

Two lawmakers from East Idaho are set to co-chair the committee: Rep. Dustin Manwaring from Pocatello, and Sen. Mark Harris from Soda Springs. The committee includes two other East Idaho lawmakers: Sen. Kevin Cook from Idaho Falls, and Rep. Josh Wheeler from Ammon.

The remainder of the committee is from North Idaho — Sen. Carl Bjerke from Coeur d’Alene, and Rep. Cornel Rasor from Sagle — or from southwestern Idaho — Galaviz and Sen. Josh Keyser from Meridian.