Health Insurance Exchange Decision Comes This Week, After Years Of Resistance, Months Of Deliberation

Molly Messick / StateImpact Idaho

The Idaho Capitol, decorated for the holidays

The clock ticks down this week on a decision Idaho lawmakers have avoided and studied and postponed for much of the last year.

On Friday, states must tell the federal Department of Health and Human Services whether they plan to form a state-based health insurance exchange, pursue a partnership with the federal government, or default to a wholly federally-run model.

Exchanges are the online marketplaces that allow consumers to assess health insurance plans based on costs and benefits.  They’re a main component of the Affordable Care Act, and they’re supposed to be up and running by 2014.

Gov. C.L. “Butch” Otter appeared to tip his hand about which way the decision will come down during remarks at the Associated Taxpayers of Idaho conference last week.  “I want to remind you that we are a republic, and one of the first and most important tenets of a republic is the rule of law,” he said, noting that many states have already opted out of creating their own exchanges.

The governor said states have in some cases come to that decision based on philosophical opposition to what he termed “the law of the land.”

“We tried to change the law. We’ve challenged the law. We’ve done everything we possibly could,” he continued.  “And now, with our best interests, and the best interests of 1.55 million Idahoans, we now have to make that decision.  It’s not going to please everybody.  Those of us who have to make the decision probably won’t be pleased about it.”

A working group convened by the governor concluded in October that Idaho should build its own health insurance exchange.  Last week, Republicans deposed longtime House Speaker Lawerence Denney, an outspoken opponent of the Affordable Care Act.  They replaced him with Rep. Scott Bedke (R-Oakley), who is thought to be a more pragmatic leader.

Also of note in the House leadership shuffle is Rep. Fred Wood’s ascendance to the top post on the Health and Welfare Committee.  Wood is a retired physician who last year co-sponsored legislation supporting a limited state-based exchange.  He replaces former Rep. Janice McGeachin, who was the only member of the Legislature’s Health Care Task Force to vote against an Otter Administration bill supporting a state-based exchange.

Some of these leadership changes may have been factors that led Sen. Sheryl Nuxoll (R-Cottonwood), vice chair of that chamber’s Health and Welfare Committee, to send an alarmed tweet to followers over the weekend. “Emergency,” she wrote. “Stop the State Health Insurance Exchange by contacting our governor by the 16th or he will probably set the exchanges up.”  (The deadline is the 14th, not the 16th.)

If all of this indicates that Gov. Otter is likely to support a state-based exchange and lawmakers are likely to get on-board, then what does that mean for Idahoans?

In their deliberations in October, members of Gov. Otter’s health exchange work group argued the state will cede less control over the local health insurance market to the federal government under the state-based model.  They said that will help keep Idaho’s health insurance costs low.  They also noted that an exchange administered in-state might be more responsive to Idahoans on things ranging from high-level policy concerns to customer service.

That said, it’s not yet clear what shape Idaho’s exchange will take, if leaders do, indeed, decide it’s in Idaho’s best interest to build a state-based exchange.  That process is still to come.  In addition, there’s bound to be much more discussion motivated by the Affordable Care Act in the approaching legislative session, as lawmakers weigh whether the state should expand Medicaid eligibility.  And for that decision, there is no looming deadline to force a yay or nay.