The Idaho Legislature's health care task force met for the first time Monday to discuss the options facing the state after the U.S. Supreme Court's decision upholding the constitutionality of the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare. Several state government officials addressed participating lawmakers and the listening public throughout the day's meeting.

The PPACA mandates that states must either set up their own health insurance exchanges, participate in a federally operated exchange, or form a partnership in which both levels of government maintain a measure of control. It also aims to expand Medicaid coverage substantially, although the court's ruling made state participation in this expansion fully optional. Many of Idaho's leaders, including Gov. Butch Otter, have declared their opposition to the law and its provisions, but they still face the difficult decisions involved in settling on a particular course of action.

"I think most citizens don't want the federal government involved in our health care decisionmaking process, and so a partnership doesn't seem like a viable answer," said Sen. Dean Cameron, R-Rupert, co-chair of the task force, in an interview with KBOI 2 News. Although Cameron has voiced his own opposition to the PPACA, he is among the state legislators who supported the creation of an Idaho exchange during this year's legislative session.

Joy Wilson, health policy director for the National Conference of State Legislatures, told the group that it's not yet clear what form an exchange operated by the federal Department of Health and Human Services (HHS) might take if the state does not create its own.

"If the state does nothing to put in place the legislative underpinnings for an exchange, HHS will contract with someone to run an exchange in the state. So, they would do all the operations, including Medicaid eligibility if they have to, because that's what the law requires," Wilson said. "So, we don't know what that's going to look like, really. And, clearly, they're going to need some state cooperation, and they will fund it through fees."

One factor making a decision difficult is the inability of government officials to estimate program costs, in either the state or federal exchange scenarios. Bill Deal, director of the Idaho Department of Insurance, said his agency does not have any firm numbers readily available.

"We've got some ballpark figures, and we need to refine those a little bit more," Deal said. "We would like to use the opportunity with this task force to really sharpen our pencil on those costs, and then they will be made public."

Costs of the potential Medicaid expansion are also still unclear, according to Richard Armstrong, director of the Idaho Department of Health and Welfare. One strong factor that prevents accurate modeling is "woodworking," the anticipation that making it easier to gain access to Medicaid coverage will expand the ranks of eligible participants even among those who previously declined coverage—effectively drawing people "out of the woodwork."

Brian Kane, assistant chief deputy in the Idaho attorney general's office, pointed out that because both legislative and executive authority would be needed to implement a state exchange, each branch could potentially stymie the preferred approach of the other.

"Both the governor and the legislature have authority, but they're both subject to checks by the respective other body," Kane said. "And so, for example, if the governor were by Nov. 16 to declare the state moving in a certain direction with regard to the health exchange, likely that declaration would also require some legislative action, meaning it would either require an appropriation in order to fund it, or it would require some sort of authorizing legislation for one of the entities involved. Therefore, if the governor made the declaration and then the legislature didn't do the follow-up, meaning they didn't implement either the appropriation or the enabling legislation, you could put the state in a position where whatever that declaration was, was not the direction that the state wound up going. And then you would fall into either a default, or whatever the newly clarified legislative direction was at that point. But whatever the legislature does is equally subject to a governor's veto."

Wayne Hoffman, executive director of the Idaho Freedom Foundation, was named earlier in July by Gov. Otter to be a member of a health insurance exchange working group headed by Deal, along with several legislators, insurance representatives, physicians and members of the business community. Hoffman has argued that Idaho should reject both a state exchange and participation in the Medicaid expansion.

"Building the exchange will deny Idaho and your constituents an opportunity to once again challenge the law and the federal rules associated with it," Hoffman wrote. "A successful litigation would force Congress to reopen this issue. Moreover, your refusal to build an exchange will protect Idaho businesses from the $3,000-per-employee tax against companies that don’t provide health insurance to its workers." He also cited figures from the Congressional Budget Office that the Medicaid expansion would cost almost $800 billion in its first decade—a sizable chunk of which would have to be paid by Idaho taxpayers.

Note: IdahoReporter.com is published by the Idaho Freedom Foundation.