Health Care Exchange in Idaho

February 9, 2013

By far the most discussed and scrutinized topic in the legislature to date is the Health Care Exchange.  This week the Senate Commerce Committee, on an 8-1 vote, approved Senate Bill SB 1042.  The bill will now be before the Senate next week for a final vote.  SB 1042 provides for the creation of a State based Health Insurance Exchange.

In my opinion, the Patient Protection and Affordable Care Act (PPACA) is not good law.  It will neither improve the quality of health care in American, nor will it reduce costs. PPACA is made up of 3 major components: 1. Medicaid, 2. Medicare, and 3. Insurance.  Each of these 3 areas will be significantly restructured.  Medicaid and Medicare will be by far more affected than the Insurance industry.  Let me address only the Insurance aspect of PPACA today.

PPACA became law on March 23, 2010.  Since then, the law has been tested in the US Supreme Court and has been declared constitutional.  Article VI, Section (2) of the US Constitution states, “This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding.  In Idaho, our Attorney General has written two official opinions that indicate state constitutionality.  PPACA has become the law of the land, until Congress in Washington alters or repeals it.

The Insurance industry has nearly completely adopted all PPACA “10 Essential Health Benefits”:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

All insurance plans will include these components, with or without an exchange.

An exchange is an online marketplace that integrates with the current software systems that determine eligibility for Medicare or Medicaid. If a person doesn’t qualify for Medicare or Medicaid, but still needs insurance, then they will enter a part of the system that shows them their private insurer options for side-by-side comparisons. A Federal Exchange would have limited numbers insurance companies represented online, while an Idaho Exchange would welcome all qualified policies by any qualified insurance company.  The Idaho Exchange would maintain sales competition (thereby reducing cost), while the federal exchange would not.

If Idaho’s legislature decides that Idaho should not run our own exchange, then beginning in January 2014, as written in the law, the federal government would step in and implement their version of an exchange. A federal exchange will not take into consideration the unique situation of any state, including Idaho. Instead, the federal government will regulate and oversee the exchange from Washington, D.C.  In other words, saying ‘No’ means Idaho will get a federal exchange and this will cost Idahoans more money and may diminish our choices of insurance plans.

Idaho has federal funding available to create an online marketplace that the Departments of Insurance and Health and Welfare will integrate with their current system that determines eligibility for Medicare or Medicaid. Important note: If a person already has purchased health insurance, has employer insurance or is already on Medicare or Medicaid then they are not required to participate in this exchange. I repeat – participation in the exchange is completely voluntary. That can be found in SB 1042 page 1, lines 28 thru 30 and again on page 4, lines 14 through 21.

Once created, SB 1042 dictates that the state exchange will be self funding (page 4 lines 11 through 13).

In my opinion, the citizens of Idaho will lose if we don’t create our own exchange because the Federal government will step in. The exchange they implement will not fit with the way we do things here, and we would not have control to change it.

The Governor and Legislators were the first in the nation to challenge Obamacare in court. We lost. Idaho has some of the lowest insurance rates in the country. Turning our system over to a federal bureaucracy will cost Idaho citizens more money and leave them with more expensive insurance coverage.

I will vote to for Idaho control of our health care by voting for an Idaho Exchange.  It is a decision that took countless hours of study, reviewing both sides of the issue, and was not taken lightly.  While I still do not like PPACA, it is important to make it function at lowest cost and most efficiently for Idahoans.  I choose to abdicate as little authority to the federal government as possible.

The bill can be found on the internet at and more information can be found here: under the heading “Hot Topics”.

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