House Minority Leader John Rusche, D-Lewiston, a pediatrician, is praising GOP Gov. Butch Otter's veto of HB 298, the grandson-of-nullification bill on health care reform, saying, "Gov. Otter prevented legal mayhem - for that he is to be thanked." He has concerns, however, about the executive order Otter signed the same day he vetoed the bill, echoing many of the bill's provisions but allowing waivers with his personal signoff; click below to read Rusche's full op-ed piece.

Op-Ed from Rep. John Rusche

Governor Otter recently vetoed HB 298.  This was the third attempt by Representative Barbieri and others to make the Affordable Care Act (Federal Health Reform, PPACA) of no  effect in the State of Idaho.  While the bill passed both Houses of the Legislature, it was clear to many of us that if HB 298 became law, the State of Idaho, local governments and Idaho businesses and families would be facing severe consequences.  In recognizing these consequences with his veto, Gov. Otter prevented legal mayhem.  For that he is to be thanked.  
The executive order signed and released the same day is not as good, however.  It states that “no executive branch department, agency, institution or employee” shall do anything to “implement any provision of the PPACA”.  It further states that no department, agency, institution or employee may provide assistance or resources to implement or enforce this federal law.  The order does provide, however, for a “waiver” from the prohibitions at the discretion of the Governor.
The Affordable Care Act provides many protections to health insurance policyholders, and benefits to Idaho citizens and businesses.  It does include some things that are very contentious such as an expansion of Medicaid eligibility and a “mandate” to purchase health insurance coverage.  These points are the basis of Idaho’s participation in a lawsuit challenging the constitutionality of the ACA.
But Federal health reform goes much further in trying to change the way healthcare is delivered in the US, and many of those changes give benefits and protections to citizens.  Idahoans are US citizens too, and until the law is changed by suit or legislative action, we have the same right to those protections as citizens of other states.  Among those are protections from arbitrary coverage reductions or denials, the provision of tax credits for small businesses covering their employees, the assurance that premium dollars go primarily to paying for care and not to insurance profits, and the availability of “high risk” coverage for pre-existing conditions.  These rights are protected through our Department of Insurance and are “provisions of the PPACA”.
A great part of the ACA includes granting programs to stimulate changes in the health system.  Among those programs are Medical Home development, Community Clinic start-up and capital support, funding to improve the electronic records and prescribing capabilities of hospitals and doctors, development of consumer (patient) information to help patients and families with their health choices.  There are also training funds to help fill some of the shortages of clinicians. These programs are here in Idaho—we have a medical home initiative, we chronically struggle to fund physician (WWAMI) and other health caregiver training.  We harm Idahoans if we cannot continue to participate and develop these programs.
The bottom line is this.  The US health care system is unsupportable as it is.  It costs twice as much as that of any other country and delivers poorer results.  And that is before the big bulge of baby boomers hits it.   Modifying how healthcare is delivered is really more important to our Country than how the financing flows.  Without participating in these Affordable Care Act initiatives, Idahoans and Idaho businesses will be left behind.  There is no other system transformation effort around.
So I support the Governor’s veto.  And hope that his waiver process is not managed in such a way to disadvantage efforts in Idaho to transform healthcare delivery.

Representative John Rusche, D-7, Nez Perce County

Dr. Rusche is a retired pediatrician and former Sr. Vice President and Chief Medical Officer of Regence BlueShield of Idaho.  He currently is the House Minority Leader