Butch Otter — the young, brash conservative legislator of almost 40 years ago — is known for rising to the House floor and famously casting a vote of “hell no” on an anti-pornography bill.
On Tuesday, Otter voted, “Meh.” Yes, the governor voiced support, again, for a state-run health insurance exchange. Yes, he’s on the right side on an emotional issue.
But he couldn’t be any less enthusiastic or more conflicted about it.
Otter’s 522-word statement Tuesday furnishes vast wiggle room — for the legislators who must approve a state-run exchange, and even for Otter himself. In spots, it was less an endorsement of a state health exchange than it was another indictment of the federal health care law that mandates an exchange.
“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 That makes it all the more important to remember that my decision today can be rescinded if the Legislature disagrees or withdrawn by me if circumstances warrant — a real possibility on such a constantly moving target.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.”
Otter knows a thing or two about the sales pitch, from his days in the corporate world to his current job, which entails hawking Idaho’s exportable goods in the global market. He also knows a thing or two about the soft sell.
It’s almost as if Otter were selling something unattractive or distasteful, which isn’t the case. There should be nothing objectionable, or even remotely controversial, about a health exchange. It’s an online marketplace that is geared to help nearly 300,000 uninsured Idahoans, individuals and small businesses, navigate the insurance market and find coverage.
The exchange is controversial by the company it keeps, and since this idea is a component of “Obamacare,” caterwauling trumps common sense.
By the sound of things, you’d think Otter was having to sell a health exchange entirely on his own. Not true at all.
Business groups have supported the exchange from the start — and that includes the Idaho Association of Commerce and Industry, the business lobbying group that usually gets what it wants around the Statehouse.
The health exchange issue has taken on such importance that a coalition of some 400 businesses, individuals and trade groups has banded together, under the umbrella Idaho Health Exchange Alliance, for the express purpose of campaigning for it. On Tuesday, executive director Heidi Low was quick to praise the governor, although she oversold a bit: “We’re very grateful that Governor Otter has shown Idaho the way forward on this issue.”
Otter also has backup from a committee he assembled to study the issue. In October, the group voted 10-2 to recommend a state-run health exchange. Surely, these committee members have the governor’s back as well.
The support for a state-run health exchange coalesces behind a simple fact and solid selling point. If states fail to act, the federal government can impose its own health exchange. A state exchange, as Otter noted at length Tuesday, gives Idaho some measure of control.
That should be a persuasive argument in a state that cherishes self-determination and bristles at federal mandates. And on that front, St. Luke’s Health System CEO and President David Pate made a good point in a Statesman editorial board meeting Tuesday. The feds expected states to jump at creating health exchanges. Now, with roughly 20 states resisting the idea, the feds will be forced to create a huge exchange and may be unwilling — or unable — to respond to states’ needs.
That’s what could await if legislators do nothing. And I would think it would compel Idaho to follow Otter’s lead.
But maybe not. In a Statesman editorial board meeting Wednesday, Wayne Hoffman of the Idaho Freedom Foundation wasn’t persuaded. One of the two task force members to oppose a state exchange in October, Hoffman says state health echange managers would remain subject to the “whimsical desires” of the feds. And as bad as a federal exchange would be, he said, at least the feds would have to own the mess it would create.
That’s the mindset and the challenge Otter faces. This governor hasn’t always had much success selling the Legislature on controversial ideas — increased gas taxes and vehicle registration fees in his first term, a health exchange a year ago. This time around, he’s going to have to sell the exchange assertively, not reluctantly. That’s what governors have to do, when a significant number of legislators stands ready to vote “hell no.”