After nearly six hours of debate, Idaho Senators voted 23-12 in favor of creating a state-based health insurance exchange.
Exchanges, or online health insurance marketplaces, are a cornerstone of the federal health care law. According to The Kaiser Family Foundation, Idaho is one of 18 states with plans to create a state-based exchange. Twenty-six states plan to default to a federally-operated marketplace.
The debate in Idaho has been going on for the last couple of years. Many Republican lawmakers said they wanted to wait for an outcome of the U.S. Supreme Court decision on the health care law, and the 2012 presidential election, before committing to a state-based exchange in hopes the law would get reversed.
Now, many of those same Republican lawmakers, including Idaho’s Governor C.L. “Butch” Otter say a state-based exchange is the best way for Idaho to maintain some control over the new system of purchasing health insurance.
Marv Hagedorn (R-Meridian) doesn’t agree with the federal health care law, but he voted for a state-based exchange. “I can’t ride this pig if it’s a federal exchange,” says Hagedorn. “I can ride it with spurs on if it’s a state exchange.”
In floor debate, many senators addressed the fees associated with a state-based exchange. The governor’s office, which wrote the bill, believes monthly fees to exchange users will be significantly lower under state marketplace than a federal one.
Gov. Otter’s chief of staff David Hensley told lawmakers earlier this month that premium fees could be $4.80 per month, which amounts to an annual cost of $57.60. A federal exchange, said Hensley, would charge monthly fees, on average, of $13.55, or $162.60 a year.
The Otter administration estimates it will cost $20 million to start an Idaho-based exchange, which will be paid for through a federal grant. The ongoing, annual cost is estimated at $10 million, and through monthly premium fees, it’s expected to be self-funded.
An Idaho-based health insurance exchange also wouldn’t be mandatory. People would not be penalized if they didn’t use the exchange. It’s still unclear how many people would sign up. With nearly 20 percent of the population uninsured, the governor’s office estimates 278,800 people could potentially buy insurance through the new marketplace.
Sen. Jim Rice (R-Caldwell) repeatedly told lawmakers the Affordable Care Act is bad public policy, but legislators have a duty to be a fiscal watchdog
for constituents. “We should protect the family budgets of Idahoans to the extent we can, from this bad federal policy,” says Rice. “I support this act because this is an area where we have no ability to win, but some ability to defend our citizens.”
The opposition didn’t bite.
Ardent opponents of Gov. Otter’s health exchange don’t believe they should be pushed into a decision without more information on rules, authority and fees.
Instead, some Republicans and one Democrat suggest a wait-and-see approach. Sen. Russ Fulcher (R-Meridian) doesn’t buy into the notion that if a state-exchange isn’t created by January 2014 that the federal government will create the marketplace for Idaho.
“We really don’t have a rush here,” Fulcher says. “Lets learn, lets understand the costs, lets understand the rules. We really don’t have much to gain by moving now, but we’ve got a lot to lose.”
Many of the senators who spoke against the health exchange bill, and some who supported it, worry these online health insurance marketplaces are a gateway to socialized medicine, or a single-payer system.
But Boise Democrat Sen. Les Bock welcomed that idea. “I want this state, and this country to know, in the state of Idaho, there is another voice.” Sen. Bock says he wanted a single-payer system, and would still like to see one. “I would have loved to see a single-payer system, but we got what was possible,” says Bock.
The debate will now reset in the House. The Idaho House has for years been seen as the more conservative,
chamber. But with nearly one-third of the House being new this session, it’s unclear to what extent the tides have changed.