Here's a draft of our Sunday editorial on the health care ruling — and its implications for Idaho.
Idaho politicos have spent two years viewing President Barack Obama’s health care law with scornful suspicion.
That is, when they haven’t covered their eyes and tried to wish the law away.
State lawmakers spent the 2011 session indulging in constitutional conceit, convincing themselves that states possessed the power to “nullify” any federal law that they don’t like.
In 2012, these same lawmakers ducked the idea of creating a state-run health insurance exchange — an online marketplace to enable individuals and small businesses to shop for insurance, and a component of the federal health care law. They explained away the dodge by saying they wanted to see how the Supreme Court would rule on health care. Clearly, many lawmakers fully expected the court to toss the law aside.
We all know how that worked out. On Thursday, the Supreme Court kept the health care law on the books in a 5-4 decision.
Despite their infatuation with nullification, it would be unfair to beat up Idaho lawmakers for guessing wrong on the health care ruling. The decision, and Chief Justice John Roberts’ emergence as the court’s swing vote, confounded many observers.
But it’s the job of elected officials to prepare for any outcome, not to govern based on partisan hopes and wishes. It’s as if Idaho political leaders — fervently opposed to the law they call “Obamacare” — refused to even entertain the possibility that the law might actually hold up in court.
Where are we now?
A health care exchange is coming. But most likely, the federal government will run it. That’s the hole Idaho lawmakers dug for themselves, by refusing to set up an exchange — and accepting “Obamacare” grant money to do it. If the state doesn’t cobble together a health exchange framework by January, the feds may establish their own exchange.
“I don’t want to say we’re unprepared,” Sen. Dean Cameron, R-Rupert, told the Post Register in Idaho Falls Thursday. “We are somewhat prepared, but we are dramatically behind the curve.”
Cameron owns an insurance agency, so we trust he knows what he’s talking about. But this is a predicament the Legislature inflicted upon itself.
The health exchange might not even be the biggest decision stemming from the court ruling. Idaho must decide whether to expand its Medicaid program to cover more uninsured Idahoans.
The Supreme Court ruling left that option to the states. Idaho could choose not to expand its Medicaid program — with no repercussions for the program and the 238,000 Idahoans now under its care.
From the standpoint of state sovereignty, this is good news. But it leaves Idaho facing a big decision.
At the outset, the feds would pay 100 percent of the costs of Medicaid expansion, covering perhaps an additional 80,000 Idahoans by 2014. After 2020, the state would have to pick up 10 percent of the costs for this added caseload — a generous match, considering that the feds pick up about 70 percent of current Medicaid costs.
Does Idaho want to take on more Medicaid patients — when the state’s ever-growing program costs now total $474.1 million, or 17.5 percent of the general fund?
Or does Idaho leave these patients to fend for themselves — and perhaps go to the payer of last resort, a growing catastrophic fund covered by state dollars and county property tax collections?
The answer will affect state budgets, and thousand of Idahoans, for years to come. It deserves thoughtful discussion and serious number-crunching.
Gov. Butch Otter did nothing to set the tone Thursday, issuing a canned and predictable statement decrying the Supreme Court ruling and calling for Congress to repeal the health care law.
Otter phoned in his statement from a week-long horseback trail ride, according to the Spokane Spokesman-Review. The bigger fact is that his leadership on health care was lacking long before he saddled up this week. Otter used his 2011 State of the State address to push for nullification — as far-fetched a fancy as repeal is now. Otter voiced support for a health exchange before the 2012 session, only to shrink away as opposition mounted in the Legislature.
Now, Idaho needs to get out of denial and get serious about health care issues. Is Otter up to the job?