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Your Health Idaho reports record enrollments and describes potential impact of Medicaid expansion repeal on exchange
Summary
Your Health Idaho director Pat Kelly told the Senate Health and Welfare Committee the exchange recorded record enrollments in open enrollment 2025, strong customer retention and financial reserves; he said repealing Medicaid expansion would move some but not all expansion enrollees to the exchange and create a coverage gap for many.
Pat Kelly, executive director of Your Health Idaho, told the Senate Health and Welfare Committee that the state-based insurance exchange recorded a record open enrollment for plan year 2025 and summarized how changes to Medicaid expansion would affect exchange eligibility.
Kelly said Your Health Idaho recorded more than 139,000 Idahoans selecting a plan during open enrollment 2025 and that average enrollment for 2024 was about 120,000 people. He said 68% of enrollees renewed coverage from the prior year, 22% of open-enrollment enrollees were new customers in 2025, and more than half of current enrollees have stayed with the exchange for four or more years. Kelly reported a net promoter score of 73 and stated Your Health Idaho has delivered $44,000,000 in savings since inception. He added the exchange is financially self-sustaining, carries no debt and maintains cash reserves equivalent to 6to9 months of operating expenses.
Kelly described a planned shift in 2025 from an assessment fee based on a percentage of premium (2.49% in 2024) to a per-member, per-month fee to improve revenue predictability. He said the exchange completed 90% of enrollments through self-service tools and reduced customer contacts while increasing enrollments, noting investments in technology, outreach and bilingual customer advocates.
On the question of Medicaid expansion repeal impacts, Kelly said the exchange's estimate is that of roughly 85,000 people currently in the Medicaid expansion population, about 19,100 have incomes between 101% and 138% of the federal poverty level and would become eligible for premium tax credits and could enroll through the exchange if expansion were repealed. He said the remainder would fall into the "coverage gap" and would not be eligible for tax credits or exchange enrollment; he recommended questions about specific Medicaid eligibility and transition impacts be directed to the Department of Health and Welfare.
Committee members asked several follow-ups about the numbers and implications; Kelly advised that more detailed Medicaid-eligibility and coverage-gap questions are best answered by Health and Welfare staff. The committee thanked Kelly for the presentation and noted he might be asked to return to testify on related bills.
