Idaho lawmakers are spending their Monday mulling big decisions related to the health of Idaho citizens in the wake of the U.S. Supreme Court's June decision to uphold key components of the Obama administration's Affordable Care Act.
On the table at a special Statehouse meeting was a proposed expansion of the state's Medicaid program (which the high court ruled unconstitutional as a mandate), the implementation of a health insurance exchange and the November presidential election.
"This may be the most-important issue facing our country," began Rupert Republican Sen. Dean Cameron. "And certainly facing our state."
The 14-member Idaho Legislature Health Care Task Force convened at the Capitol to listen to analysis from the state departments of Insurance, Health and Welfare and the Attorney General's Office.
Joy Wilson, health policy director for the National Conference of State Legislatures, participated via phone, guiding the panel through an analysis of the Supreme Court decision to uphold key elements of the Patient Protection and Affordable Care Act, the full title of the law opponents dub "Obamacare."
Questions quickly turned to health insurance exchanges. Idaho can implement and administer its own exchange or the federal government will install one. Sen. Cameron expressed concern about the federal government stepping in.
"I wonder if you could outline for us what could be at risk for the state, should the State of Idaho choose to do nothing?" Cameron asked Wilson. "There are some advocating that we should do nothing, and put all our eggs in the [presidential] election basket, and somehow hope that will work out to our favor."
To that, Wilson said the biggest risk with the federal exchange would be not liking how it is administrated.
However, the Medicaid program, because it is so entwined in state budgets, is a more complex decision.
"The Medicaid expansion affects every state differently. I think at this point, most states are in the process of running numbers to try to determine just what the impact of expansion will be in their state," said Wilson.
Idaho is left with a choice: expand its Medicaid program to cover childless adults under the age of 65, with federal dollars fronting much of the cost, or not.
State officials with the Idaho Department of Health and Welfare had already begun looking into those details. A presentation given by Health and Welfare Director Richard Armstrong and Division Administrator Russell Barron included timelines for implementing new systems to take on more Medicaid enrollments.
Health and Welfare also commissioned two studies to look at the number of people who would be covered should Idaho implement the expansion. Information from the Kaiser Family Foundation estimated an additional 85,000 Idahoans could be covered.
"We’re trying to understand where these individuals which could be a part of the expansion are receiving services today," said Armstrong.
Idaho must also define what benefits for possible new Medicaid enrollees would look like.
Next, the panel heard from Brian Kane, assistant chief deputy from the Office of the Attorney General. He said that the AG's office had no plans for further litigation to stop the implementation of the ACA. But Cameron asked if the AG's office was surprised to hear that the Supreme Court had upheld much of the law.
"Insofar as I can speak on behalf of Attorney General [Lawrence] Wasden, the answer is yes. I think everyone watching this case was surprised," said Kane.
Coeur d'Alene Republican Sen. John Goedde asked if the governor could take the lead on steering the future of Idaho's health care plans, or if the Legislature needed to take initiative.
Cameron earlier said the panel didn't want to get ahead of two working groups formed by Gov. C.L. "Butch" Otter. Earlier in the day, discussions turned to whether the Idaho Legislature or the Governor's Office should take the lead in the state's decisions.
Ultimately, said Kane, either branch could move forward on implementing the ACA.
"Both the governor and the Legislature have authority, but are subjected to checks by the other authority," he said.