“You’ll notice in fiscal year 2015 there’s quite a significant decrease,” Catastrophic Health Care Fund board Chairman Roger Christensen told lawmakers on the Joint Finance-Appropriations Committee this morning. It’s a trend the state is welcoming; both the case load and state payments have fallen precipitously since close to 100,000 Idahoans signed up for health insurance on the Your Health Idaho insurance exchange, the vast majority of them receiving subsidies to make the plans more affordable. “This has been probably more successful than anyone anticipated,” Christensen said. “77,000 Idaho individuals signed up that qualified for the subsidies,” and another 10,000 bought plans on the exchange last year without subsidies; those numbers have since grown. Many of those might otherwise have turned to the CAT fund, Christensen said.

The CAT fund is the state portion of Idaho’s system for paying the catastrophic medical bills of Idahoans who can’t afford to pay. Counties cover the first $11,000 of each bill from local property taxes; amounts exceeding that are picked up by the CAT fund. People whose bills are covered get liens placed on virtually everything they own, including their estates when they die, but relatively little is recovered.

JFAC is holding its budget hearing today on the CAT program. County payments under the program have dropped from $22.5 million in 2014 to $17.7 million in 2015, not as large a drop as the state has seen; state payments dropped from $28.9 million in 2014 to $18.6 million in 2015. Overall, the combined program has dropped from $51.5 million in fiscal 2014 to $36.3 million in 2015. The number of approved cases dropped from 1,109 in 2014 to 721 in 2015; so far this year, just 308 cases have been approved.

“The biggest factor has been the insurance exchange, the success of enrollment in that,” said Christensen, a Bonneville County commissioner.

For fiscal year 2017, the CAT fund’s budget request is $22 million, which suggests a $5 million base reduction in the program. “We took our best estimate,” Christensen said. “Based on the six-month activity and some of the other factors we’ve seen, we feel pretty comfortable suggesting that maybe that base reduction be adjusted from $5 million to $8 million.

Sen. Jim Guthrie, R-McCammon, said, “I can tell you from when I was a county commissioner, this is a complete turnaround.” He praised the work of the CAT program and its board, including two physician-lawmakers, Sen. Dan Schmidt and Rep. John Rusche. “Obviously we can argue the ACA aca may be detrimental to some other areas of our economy,” Guthrie said, “but it’s certainly showing up positive on the CAT fund.”