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HHS secretary Alex Azar. Photo: Win McNamee/Getty Images

Blue Cross of Idaho is taking up the state’s controversial offer to sell insurance plans that don’t comply with the Affordable Care Act — a move many legal experts believe is illegal, and which policy experts say will undermine the ACA.

What’s next: It’s not clear whether the Trump administration will step in to enforce the ACA’s requirements. If it doesn’t, more conservative states will likely follow Idaho’s lead, effectively rolling back some of the ACA’s most substantial consumer protections and coverage mandates.

Driving the news: Idaho Gov. Butch Otter previously said the state would allow the sale of insurance plans that don’t comply with all of the ACA, and Blue Cross of Idaho announced today that it would start selling some of those plans next year.

The details, according to plan documents provided by Blue Cross and a report in the Idaho Statesman:

  • These new plans will ask consumers about their medical histories and charge them higher premiums if they have pre-existing conditions. That’s illegal under the ACA.
  • The policies will cap their total coverage for each customer at $1 million per year. The ACA banned annual caps.
  • Some out-of-pocket costs, like co-pays for certain services, would be lower in the new plans than in the company’s ACA-compliant policies. But consumers would be on the hook for more out-of-pocket spending overall.
  • Consumers could not apply the ACA’s premium subsidies to these new policies.

Why it matters: This is the most aggressive effort any state has made to circumvent the ACA. If these policies do come to market next year, they’ll likely siphon off healthier customers who don’t use much health care — which in turn would leave a sicker, more expensive customer base in the market for ACA-compliant coverage, causing those plans’ premiums to rise.

  • If neither the Trump administration nor the courts intervene to block these policies, this could be a roadmap for other red states to create their own parallel insurance markets.

The odds: Health and Human Services secretary Alex Azar told a House committee today that Idaho hasn’t asked for a specific waiver from the ACA, and did not explicitly say how his department would approach Idaho’s experiment.

  • “There is a rule of law that we need to enforce,” Azar said.

Go deeper

Scoop: U.S. begins denying Afghan immigrants

Afghan refugees on a bus bound for temporary housing after arriving in Greece. Photo: Byron Smith/Getty Images

The Biden administration has begun issuing denials to Afghans seeking to emigrate to the United States through the humanitarian parole process, after a system that typically processes 2,000 applications annually has been flooded with more than 30,000.

Why it matters: Afghans face steeper odds and longer processes for escaping to the U.S., despite the earlier sweeping efforts by the Biden administration to assist its allies. Immigration lawyers and advocacy groups say the government has set untenable barriers to a safe haven in the U.S.

45 mins ago - Politics & Policy

Dems invoke Robert Byrd to sell Manchin on Senate rules changes

Photo illustration: Shoshana Gordon/Axios. Photos: Diana Walker, Chip Somodevilla/Getty Images

A small group of Senate Democrats is privately invoking the legacy of late West Virginia Sen. Robert Byrd in an effort to sway Sen. Joe Manchin (D-W.Va.) to support their plans to change the chamber's rules, Axios has learned.

Why it matters: Manchin — who holds Byrd's Senate seat — has often referenced his predecessor's strong moral conviction and insistence on preserving the Senate as an institution, as justification for some of his tough positions.

House votes to ban imports from Xinjiang over forced labor concerns

House Speaker Nancy Pelosi. Photo: Anna Moneymaker/Getty Images

The House voted 428-1 on Wednesday to pass a bill that would ban all imports from the Chinese region of Xinjiang unless the U.S. government determines that the products were not made with forced labor.

Why it matters: Both the Trump and Biden administrations, as well as several foreign parliaments, have recognized China's repression of Uyghurs and other Muslim minorities in Xinjiang as genocide.