Supreme Court Ruling Means Decisions Ahead For Idaho Lawmakers

Molly Messick / StateImpact Idaho

Rep. John Rusche (D-Lewiston) advocated for a state-run health insurance exchange before the start of the 2012 legislative session.

The U.S. Supreme Court handed down its most anticipated decision since Bush v. Gore yesterday, when it upheld the central provisions of the Affordable Care Act.

While there’s wisdom in waiting for the dust to settle before issuing predictions about just how this will affect Idaho, it’s clear the ruling has implications for the state.  For example, the Idaho Legislature did not act to establish a state-run health insurance exchange in the most recent legislative session.  In not moving to create a state exchange, the Legislature went against the Idaho Department of Insurance’s position, and the will of the state’s most powerful business lobby.

As Rep. Janice McGeachin (R-Idaho Falls) told StateImpact this week, that lack of action can be chalked up to lawmakers’ hopes that the Supreme Court would strike down key aspects of the law.  “Why would we put something into place willingly at the same time we’re tied up in a lawsuit with the federal government on that same issue?” she asked.  “We felt that would weaken our standing, and would put that lawsuit in jeopardy.”

Now, state leaders appear to have decisions to make.  Guidance from the U.S. Department of Health and Human Services requires states to submit an exchange blueprint by November 16th, 2012 in order to have their plans in place by the 2014 deadline.

The Idaho Legislature does not meet again until January.  Given that, House Minority Leader John Rusche (D-Lewiston) says there seem to be two ways for Idaho to plan for a state-run exchange before that deadline.

“We can’t wait for legislative action, unless the Governor calls a special session,” Rusche explained.  “He would have to do it by an executive order saying that the law of the land has been determined by the Supreme Court, and it’s in the best interest of Idaho to proceed.”

Gov. C.L. “Butch” Otter recently told the Times-News’ Melissa Davlin that a special session is off the table, no matter the Supreme Court’s decision.  Moreover, in his written response to the ruling, Gov. Otter did not strike a conciliatory tone.  “Change is now in the hands of the American people and we must elect a new president and congressional candidates who will repeal Obamacare and protect our freedom to remain the architects of our own destiny,” he said.  

The Idaho Association of Commerce and Industry (IACI) has been among those calling for a state-run exchange, on the grounds that state control is better for Idaho citizens and businesses.  Today, the association repeated that appeal.  “Idaho should do something on an exchange if we can still pull it off,” IACI President Alex LaBeau said in an email.  However, Department of Insurance Director Bill Deal tells The Spokesman Review that the $20 million federal grant Idaho received to establish an exchange is no longer available, after legislators rejected it last session.

Another major question facing state lawmakers in the wake of the ruling is what course to take on the Affordable Care Act’s Medicaid expansion.  The Supreme Court’s decision says the federal government cannot require that states either expand their Medicaid programs or lose all federal Medicaid funding.  In other words, the ruling in effect gives states the option of keeping their Medicaid programs as they are.  Idaho Attorney General Lawrence Wasden hailed that part of the decision as a victory for states’ rights.

As StateImpact reported this week, a Kaiser Family Foundation study predicts Idaho Medicaid enrollment could increase by as many as 115,000 people under the expansion prescribed by the Affordable Care Act.  Although the federal government would cover the lion’s share of the associated costs, state spending could rise by $100 million to $133 million between 2014 and 2019.

Nevertheless, Rep. Rusche believes it is in Idaho’s financial interest to undertake the expansion.  He says expanding eligibility to 133 percent of the poverty line could greatly diminish the state and county costs associated with Idaho’s catastrophic health care fund.  “Based on the amount of support from the federal government, it would be a financial benefit to expand Medicaid,” Rusche said.

Even if that proves to be true, ideological opposition to the Affordable Care Act may be a significant factor in lawmakers’ willingness to support the expansion.  “I think it will be a very large sticking point,” acknowledged Sen. Dean Cameron (R-Rupert).  But, like Rusche, Cameron believes expanding Medicaid eligibility could be in the state’s favor, for reasons including potential savings in the state’s catastrophic health care fund spending.

“People’s ideological opposition may be assuaged if they have information in front of them showing that it may save the state money,” he said of the Medicaid expansion.  “I have confidence that we will evaluate all of the pros and cons.”