UPDATED, 5:41 p.m., with comments from the Idaho Health Exchange Alliance, which supports the exchange.
Gov. Butch Otter says he will pursue a state-run health insurance exchange — setting up, potentially, a battle with legislative conservatives.
The exchange — an online marketplace allowing individuals and businesses to shop for health insurance — is a component of the federal health care law, opposed by Otter and legislative Republicans. But the law allows the federal government to impose an exchange in states that refuse to create their own exchange, an option noted by Otter in a news release today.
"Our options have come down to this: Do nothing and be at the federal government’s mercy in how that exchange is designed and run, or take a seat at the table and play the cards we’ve been dealt. I cannot willingly surrender a role for Idaho in determining the impact on our own citizens and businesses."
Otter last year expressed support of an exchange, which has long been backed by business groups. But Otter backed off amid legislative resistance.
States have a Dec. 14 deadline to announce whether they will pursue a state exchange.
My quick take: The fight isn't over.
First, the Legislature has to approve the exchange. Otter says he consulted with legislative leaders before making his decision.
Second, Otter even gives himself wiggle room. He says his decision can be rescinded "if circumstances warrant — a real possibility on such a constantly moving target.” It reads like a governor who felt he had to pursue an exchange, but not a governor who wanted to pursue one.
Here are Otter's comments, from a news release:
“This is not a battle of my choosing, but no one has fought harder against the mandates and overreaching federal authority of the Affordable Care Act. No one has more consistently and clearly demanded that Idaho retain the authority and flexibility to chart our own path forward. There was a judicial process for challenging Obamacare, and the presidential election was at least in part a referendum on its enactment. But despite our best efforts, the law remains in place, and almost certainly will for the foreseeable future. There will be a health insurance exchange in Idaho. The only question is who will build it.
"Our options have come down to this: Do nothing and be at the federal government’s mercy in how that exchange is designed and run, or take a seat at the table and play the cards we’ve been dealt. I cannot willingly surrender a role for Idaho in determining the impact on our own citizens and businesses.
“This decision does not signal support for the law or how it is being implemented. However, it does reflect my continued determination for Idaho to be actively engaged in making the best possible choices — to the degree we are allowed — in the interest of more accessible and affordable health care for our citizens.
“Obamacare is not the answer. In fact, it very likely will do little or nothing to reduce costs while force-feeding us coverage and increasing the size and scope of government. But it is an unfortunate and unwelcome reality, and it would be irresponsible of me to simply abandon the field to federal bureaucrats. In the face of uncertainty we must assert our independence and our commitment to self-determination while fulfilling our responsibility to the rule of law.
“The working group I assembled to study our options recommended this response. I greatly appreciate and respect the members of that panel their analysis, both the majority and those in dissent. I also consulted with national experts, many of my fellow governors and our own legislative leaders. I understand and empathize with those who would reject a role in this process, as some other states have done. I know that for many this is not a matter of consensus but rather of individual conscience, and I know the earnest and well-intentioned debate will continue.
“I take some comfort in the fact that even those disagreeing with this decision strongly believe as I do in Idaho’s ability to be more responsive and do a better job than the federal government alone of ensuring our citizens can make informed choices about their health care.
“All the criticisms of the exchange mandate that I and many others have expressed remain valid and troubling. The law is governed by an evolving set of increasingly complex rules and requirements. It is onerous, unwieldy and fraught with unknowns. That makes it all the more important to remember that my decision today can be rescinded if the Legislature disagrees or withdrawn by me if circumstances warrant – a real possibility on such a constantly moving target. But with what we know today, this is our best option.”
And from the opposition camp, here's a statement from Idaho Freedom Foundation Executive Director Wayne Hoffman. Hoffman was a member of an Otter task force that voted 10-2 to endorse a state exchange; Hoffman was one of the dissenters:
"I have a great deal of respect for my friend, Gov. Otter. However, I strongly disagree with his decision. More than 20 states have indicated that they will not implement a state exchange. States are opposed because they understand that Obamacare depends entirely on states to implement it. States are opposed because they know that a state exchange affords almost no flexibility and makes states co-owners of the looming disaster in medicine: higher insurance premiums, more expensive medical care, reduced accessibility and worse patient outcomes. Gov. Otter's decision makes the national effort of resistance much more difficult and more likely the law will remain in place, at great cost to Idaho families, businesses and our nation's economic vitality. Idaho Freedom Foundation will do everything it can, along with other opponents of Obamacare, to make sure Idaho never implements this destructive law."
The Idaho Health Exchange Alliance, a coalition of more than 400 businesses, individuals and trade associations, praised Otter's call. From executive director Heidi Low:
“We're very grateful that Governor Otter has shown Idaho the way forward on this issue. A state-based exchange will help Idaho have more control over Idaho's health insurance costs and keep Idaho in the driver's seat on health insurance issues. ...
“The governor's decision today allows Idaho to be actively engaged in making the best possible choices on behalf of its citizens. The Idaho Health Exchange Alliance appreciates his commitment to doing what is best for Idaho.”