Short-term health insurance plans that don’t comply with all of the Affordable Care Act’s requirements will be available in Idaho starting Jan. 1.

Supporters of these plans say they will help people such as younger people, farmers or small business owners who have been priced out of the health insurance market and could use cheaper and less comprehensive health plans as well as helping the larger insurance market by getting these often younger and healthier people back into the pool. Gov. Brad Little’s office put out a news release Tuesday announcing their availability, calling them an alternative for people who don’t qualify for federal tax credits to buy subsidized insurance on the Your Health Idaho state exchange.

“I have heard the concerns of Idaho families who want coverage but have been unable to afford it,” Little said. “Enhanced short-term plans provide good coverage at better prices. The plans are another way we are working to make health care more affordable for Idaho families.”

However, not everyone is a fan of them. Four high-ranking congressional Democrats sent a letter to U.S. Department of Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma opposing the idea and asking a list of questions about the federal departments’ discussions with Idaho officials.

“We are concerned that Idaho’s state-based marketplace, Your Health Idaho, is planning to make available subpar, short-term health plans to consumers who come to its website seeking comprehensive health coverage,” the four wrote in the letter, which was first reported by Politico. “Directing consumers to such plans over those that provide comprehensive coverage would harm consumers with pre-existing conditions.”

The letter is from Sens. Ron Wyden, D-Ore., and Patty Murray, D-Wash. who are the ranking members of the Senate committees on Finance and on Health, Education, Labor and Pensions, respectively; and Reps. Richard Neal, D-Mass., and Frank Pallone, D-N.J., chairmen of the committees on Ways and Means and Energy and Commerce. The four Democrats argue that Idaho and the insurance companies would violate federal law if it makes non-ACA-compliant plans available on the Your Health Idaho website. Exchange enrollment closed Monday.

“This represents another attempt by Idaho to offer substandard health plans in a manner that is inconsistent with federal law,” they wrote. “The last time this happened, you rightly stepped in to warn Idaho that moving forward would mean the state was failing to substantially enforce federal health standards and consumer protection under the ACA. We urge you to step in once again.”

These short-term plans are not available through Your Health Idaho, said spokeswoman Meghan McMartin.

“Your Health Idaho is working with insurance carriers and the Idaho Department of Insurance to understand potential offerings of enhanced short-term plans on a secondary technology instance, separate from the current exchange platform,” she said.

The state Department of Insurance has approved five enhanced short-term plans, three being sold by Blue Cross of Idaho and two by SelectHealth, with other insurers expected to follow in their footsteps, according to the news release from Little. The news release says the plans, unlike traditional short-term plans, offer more protections for people with pre-existing conditions and better benefits; are convertible to ACA-compliant plans; are guaranteed issue, meaning a consumer cannot be denied coverage; and are also guaranteed renewable for up to 36 months.

“Enhanced short-term plans will help stabilize the market as they provide healthy Idahoans with an affordable alternative,” said Department of Insurance Director Dean Cameron. “I am grateful for Governor Little’s leadership and the Idaho Legislature’s foresight as they listened to the concerns of Idaho families who have been priced out of coverage.”

The plans cost less but don’t offer all of the coverage and protections as ACA-compliant plans. The Idaho Statesman reported in November, in a story on Blue Cross’ Access plans, that a person who lives in Ada County, is 39 years old, doesn’t use tobacco and has no medical conditions or prescriptions would pay between $207 and $329 a month for the Access plans, compared to $331 to $554 a month for Blue Cross plans sold on the exchange. However, the Statesman reported the Access plans include a $2 million a year coverage limit, can charger sicker people more and, in certain circumstances, can deny coverage for pre-existing conditions, including pregnancy.

Gov. C.L. “Butch” Otter and then-Lt. Gov. Little signed an executive order in January 2018 directing the Department of Insurance to come up with guidelines allowing insurers to sell these lower-cost plans. CMS said in March 2018 that the state’s original proposal would violate the ACA. However, state officials kept working on the idea, and later in 2018 the Trump administration released new rules saying insurers could sell 12-month short-term plans that are renewable for up to three years. The Legislature passed a bill during this year’s session authorizing the short-term plans that will soon be available.