BOISE – Idaho leaders were stunned by Thursday’s ruling upholding the federal health care reform law, and they face big decisions on how to respond.
State lawmakers this year refused to set up a state insurance exchange under the law, betting instead that courts would overturn it. They rejected $20 million in federal grants for the exchange.
Idaho House Minority Leader John Rusche, D-Lewiston, a retired physician and health insurance executive, said the ruling “means we have a lot of work to do.”
State Insurance Director Bill Deal said he’s studying Thursday’s decision and weighing how to proceed, adding that he was surprised the law’s individual mandate was upheld.
He said of Idaho’s health insurance exchange, “It leaves us basically at square one.”
It’s unclear whether the federal government will now impose a federally run exchange on Idaho, since Idaho hasn’t moved to set up a state-run exchange. “At this point I can’t tell you,” Deal said.
The rejected federal grant is “essentially off the table,” Deal added. Other grants are available, and the state will need to decide whether to apply for grants and “… if the Department of Insurance and Health and Welfare will get spending authority to move forward with what now would be implementation.”
Idaho officials also were taken by surprise by the court’s ruling that states can choose whether or not to comply with the law’s requirement to massively expand their Medicaid programs. The state currently limits Medicaid to certain low-income populations, but the federal law expands it to everyone under 65 who makes less than 133 percent of the poverty level. At least initially, the federal government would pick up the added cost.
Idaho’s Department of Health and Welfare estimates the change would add 100,000 to 160,000 people to Idaho’s Medicaid program, which now has just over 223,000 enrolled, 70 percent of them children.
North Idaho Rep. Vito Barbieri, R-Dalton Gardens, who’s been among the Idaho Legislature’s most outspoken opponents of the health care reform law, said, “I know if the states do not comply, that they at least can’t strip the regular Medicaid help that the federal government is doing. But what does that mean for our constituents, and what is the added burden to the taxpayers in Idaho? How will the law affect their burden?”
For now, Idaho doesn’t have those answers.
“The state has no power to stop the federal government from taxing, so that kind of shoots any aggressive action to try and blunt the intrusion that I’ve been talking about over the last couple of years,” Barbieri said. He said he’s still analyzing the decision to see if there’s a way states can fight it, but he hasn’t found one yet.
Idaho’s all-Republican congressional delegation unanimously decried the ruling and called for repealing the law.
“It is not the ruling that the American people wanted.” said Idaho Sen. Mike Crapo.
Idaho Gov. Butch Otter was away on a multiday horseback trail ride Thursday and wasn’t available for comment; nearly seven hours after the ruling, his office issued a statement after talking with the governor by phone. “Obamacare has been bad for America from the beginning,” Otter said in the statement. “This is a sad day for self-determination and for individual liberty.”
Rusche said the Legislature’s failure to act this year on an exchange “leaves us kind of behind.” He said, “I know the Republican mantra is ‘We’ll just go and repeal it,’ but the fact is that it’s the law of the land, and my guess is that there will be some action to try to comply.”
Idaho was one of 26 states that sued to overturn the law.
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