Legislation establishing a state-run health insurance exchange passed the Idaho Senate on a 23-12 vote Thursday, following a passionate, six-hour debate.
The vote sets up a final showdown in the House, where 16 freshmen Republicans have already expressed qualified support for the measure.
The bill was introduced by Gov. C.L. (Butch) Otter. It would create a 16-member commission to develop and manage an exchange or online marketplace, where individuals and small businesses could shop and compare various insurance plans.
Given all the unanswered questions about how an exchange will operate and what federal regulations will apply, several senators urged a wait-and-see approach. Acting now, they said, could result in years of regret.
"If we pull the trigger, there's no going back," said Sen. Russ Fulcher, R-Meridian. "If we voluntarily engage, that puts us in the position of being the enforcement arm (for the Affordable Care Act). I don't want to put the state in the position of having to enforce a law we don't like."
Most senators, however, felt the only alternative would be to default to a more expensive, less responsive federal program.
"I agree there are still many unknowns," said Sen. Todd Lakey, R-Nampa. "But there are two knowns: First, either we're going to have a federal exchange or a state exchange. And second, the federal government doesn't operate programs that are less expensive, more efficient or more responsive to the citizens of Idaho. When faced with the reality of a federal exchange, I think we have an obligation to stand between the federal government and the citizens and business owners of Idaho."
The floor debate started at 9:45 a.m. and continued almost without pause until 4 p.m., with 21 of 35 senators taking part.
Virtually all of the speakers expressed dismay that Congress forced this choice upon the states. The only exception was Sen. Les Bock, D-Boise, who offered a thundering defense of the federal legislation.
"The Affordable Care Act may not have been the best possible solution, but it was the solution that was possible," he said. "It was possible because more and more middle class and poor people can't afford health care, and we needed a solution to address their needs. Obamacare was that solution, and I am so proud of my president. It's a credit to him and to the nation that we've actively tried to find a solution for middle class and poor people who otherwise couldn't get health care."
The Affordable Care Act mandates that everyone purchase health insurance or get it through their employer. Some individuals would be eligible for federal subsidies, but only if they buy insurance through an exchange.
Sen. Steven Thayn, R-Emmett, said the best estimate he could find was that Idahoans might receive more than $225 million in subsidies.
"What if that goes away in the future?" he asked. "Are we building expectations that can't be sustained? I'm concerned about creating a new entitlement program when we can't pay for the ones we currently have."
Senate Majority Leader Bart Davis, R-Idaho Falls, noted Idaho currently has some of the lowest insurance costs in the nation.
"In my opinion, Idaho surrenders more than most other states by simply saying no (to a state-run exchange)," he said. "If Idaho does nothing, federal regulators will exclusively build Idaho's health care system. I worry what the federally imposed insurance rates would be."
Sen. Curt McKenzie, R-Nampa, agreed a state exchange offers benefits over the federal model, but said it came at too high a price.
"I understand a state exchange will be less costly and will give us more control, but I won't be complicit in the federal government taking away our rights," he said.
Sen. Marv Hagedorn, R-Meridian, was as frustrated as everyone else by this either-or choice, but he wasn't prepared to surrender the field.
"When you're facing a fight, you don't turn your back on your opponent," he said. "You stay in the fight Our choice is a federal or state exchange. I can't ride this pig if it's a federal exchange. I can ride it with spurs on if it's a state exchange. If we question whether it's doing wrong to our people and our businesses, I can spur that pig. We can't do that under a federal exchange. That's where I'm coming from. This is a fight we can't turn away from."
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How they voted:
Sen. Sheryl Nuxoll, R-Cottonwood -- No
Nuxoll was the only local lawmaker to debate the bill. She was concerned about federal regulations requiring contraceptive benefits to be included in any exchange insurance plan, saying they could act as substances that induce abortion. She also worried a state exchange would help implement an unjust law.
"We're setting up socialized medicine," Nuxoll said. "How does controlling an unjust law make it just?"
Sen. Dan Johnson, R-Lewiston -- No
While he liked the concept of an insurance exchange, Johnson wasn't willing to accept all the federal mandates that came with it. He also heard from a number of rural constituents who strongly opposed the governor's bill.
"I'm not going to tell them they're right or wrong," he said. "I'm just going to try to listen to them as best I can."
Sen. Dan Schmidt, D-Moscow -- Aye
Schmidt hoped the governor's bill would prompt a discussion about the health care issues facing Idaho and the nation.
"There's obviously a lot of strong feelings here," he said after the debate. "We can see this as a positive choice or (a burden). What vision do we have for health care in Idaho?"
Distributed by MCT Information Services
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