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Nearly two weeks after the U.S. Supreme Court upheld the national health care reform law, Idaho Gov. Butch Otter has issued his reaction. “Like nearly everyone else, I was surprised by the U.S. Supreme Court’s ruling,” he writes in an op-ed piece distributed to Idaho newspapers and media. “Rather than vindication for Idaho’s legal challenge to Obamacare or clarity about a path forward, the court’s decision left me and many others with more questions than answers.”
Otter said he's not ready to join those GOP governors who already have declared they won't implement either a health insurance exchange or a Medicaid expansion, hoping instead that President Obama will be defeated and the law will be overturned in the future. “I can’t fault them for that approach and I share their desire for that outcome, but I can’t yet join them in putting all our policy eggs in that basket,” Otter writes. “My priority remains finding Idaho solutions that make quality health care more accessible and affordable for all Idahoans. To that end, rest assured I will continue working for market-based solutions while resisting tax increases and imposition of more unnecessary government bureaucracy. But I also will not put Idaho citizens in the position of hoping and working for the best outcome without also preparing for the worst.”
The governor said he's putting together working groups to research the issues surrounding the exchange and the Medicaid expansion and Idaho's options; the groups will give him their findings and recommendations by fall. Click below to read his full op-ed; meanwhile, three Democratic state representatives, Reps. Phylis King, Sue Chew and Shirley Ringo, have sent out an op-ed piece hailing the benefits of the court decision for Idaho women, from expanded coverage for preventive services to closing the “donut hole” for seniors on prescription drug coverage; you can read their piece here.
Idaho Rep. Raul Labrador has joined Sen. Jim DeMint, R-S.C., Rep. Michele Bachman, R-Minn., and a group of other national lawmakers in signing a letter urging all 50 states' governors not to implement health care exchanges as required under the national health care reform law that last week was upheld by the U.S. Supreme Court.
“I urge Governor Otter to not implement an expensive, intrusive, punitive health exchange on the businesses and people of Idaho,” Labrador said in a statement. “I urge all Governors to let Congress finish the job the American people sent us to do, to fully repeal Obamacare and replace it with common-sense free market solutions.”
In Idaho, businesses interests, including the state's health insurers and the Idaho Association of Commerce and Industry, have been calling for setting up a state-run exchange to avoid having a federal exchange imposed on the state; in this year's legislative session, lawmakers declined to act, betting instead that the high court would overturn the law, but it didn't. Click below to read Labrador's full statement; here's a link to the letter.
Idaho Chooses Life (ICL), the largest pro-life group in the Gem State, has formally declared its opposition to lawmakers giving the green light to building a state-based health insurance exchange. In a statement released to IdahoReporter.com Tuesday, ICL president David Ripley says the Patient Protection and Affordable Care Act (PPACA), the law through which exchanges are derived, is ripe with questionable policies. “ObamaCare is loaded with subsidies for the abortion industry, which is why Planned Parenthood is pushing so hard for its enactment,” Ripley said. “We are very worried about the move to voluntarily assist in the federal take-over of health care in Idaho. It jeopardizes conscience rights of employers, contains massive subsidies for the abortion industry and will lead to rationed care for the elderly and disabled”/Dustin Hurst, Idaho Reporter. More here.
Aiming to leverage their limited numbers to win hearings on Democratic priorities, House Minority Leader John Rusche suggested Tuesday that his most-liberal members could vote with the most-conservative Republicans against creating a state-run health insurance exchange. Gov. C.L. “Butch” Otter wants to use $20.3 million in federal funding to establish an Idaho exchange, the online marketplace foreseen by the 2010 federal health care overhaul to help uninsured individuals and small businesses compare and buy coverage. But to do it, Otter needs at least 36 votes in the 70-member House. With many of the 57 GOP members, especially arch conservatives, likely to reject using federal money on philosophical grounds, Rusche, D-Lewiston, said his 13-member caucus could play a crucial role/John Miller, AP. More here.
- Lawmakers learn Otter's budget wouldn't restore cuts
- Dems' State of State response: 'Culture of arrogance and entitlement'
- Commerce grants are only cuts restore in 2013 budget'
- Budget tries to reduce reliance on one-time money for ongoing programs
- Occupy Boise leaves modest marks on opening of 2012 Legislature/Dan Popkey
- Opinion: Some Idaho State of the State remarks/Randy Stapilus, Ridenbaugh Press
- Otter backs exchange creation but didn't budget for it in 2013/Dustin Hurst, Idaho Reporter
Question: What do you make of the strategy outlined above of liberal Democrats joining hard line Republicans to block a state-run health insurance exchange?
The Legislature's Health Care Task Force has voted 11-1 to endorse the draft legislation for an Idaho health insurance exchange, and to “send it to a germane committee to let them determine whether it's best for the state or not,” in the words of Sen. Joyce Broadsword, R-Sagle, who made the motion. The sole “no” vote came from House Health & Welfare Chairwoman Janice McGeachin, R-Idaho Falls. “I am not opposed to the idea of setting up an exchange in our state, but I do have some concerns with this legislation the way it's drafted,” McGeachin said/Betsy Russell, Eye On Boise. More here.
More coverage from Eye On Boise:
- Cigarette tax hike backers revising bill
- Lawmakers hear latest surplus estimates
- Idaho's insurance exchange would be market-driven
- Man charged with spray-painting 'I'm not a terrorist' on federal courthouse
Question: What would Vito say?
The word of the day is “maturity.” As in: “Politicians demonstrate maturity when they put aside their fear about Obamacare and implement the law.” Maturity. Gov. Butch Otter told reporters a few days ago that Idaho must move forward with the creation of a state health insurance exchange, as required by Obamacare, lest the federal government cut its contribution to the state’s Medicaid program. “We’re facing a $300 million expense” if the state doesn’t create a health insurance exchange, Otter warned. “We’re either going to have to raise taxes, which I see no appetite for that, or we’re going to have to cut from someplace else.” Otter said it’s one more reason the state should move ahead with the insurance exchange. I consider Butch Otter a friend. We have a common mentor, the late Ralph Smeed. I think Butch’s heart is in the right place. But by golly, I don’t buy the $300 million claim/Wayne Hoffman, Idaho Freedom Foundation. More here.
Question: Do you hold a “mature” position on the controversial health insurance exchange?
The Legislature's Health Care Task Force has voted 11-1 to endorse the draft legislation for an Idaho health insurance exchange, and to “send it to a germane committee to let them determine whether it's best for the state or not,” in the words of Sen. Joyce Broadsword, R-Sagle, who made the motion. The sole “no” vote came from House Health & Welfare Chairwoman Janice McGeachin, R-Idaho Falls; you can read my full story here at spokesman.com.
“I am not opposed to the idea of setting up an exchange in our state, but I do have some concerns with this legislation the way it's drafted,” McGeachin said. “I have … offered to sit down with the director of insurance about some of my concerns. I'm not opposed to the idea of an exchange in Idaho, but I do have some particular concerns with the way this bill is drafted.”
Rep. John Rusche, D-Lewiston, said, “As always, the devil's in the details and the plan of operations is really going to say whether this is successful and meets the needs of Idaho. But as far as the framework, I think it's probably as good as we can get. I support the committee's endorsement.” Sen. John Goedde, R-Coeur d'Alene, said as he cast his “yes” vote, “I'm going to vote to support this, but I would be open to looking at amendments that might improve it.”
The Legislature convenes on Monday.
State Insurance Director Bill Deal said the proposed health insurance exchange legislation would set up a “state-operated, market-driven health insurance exchange.” Part of what that means has to do with a Dec. 16 bulletin from HHS that said states can decide the “benchmark plan” or minimum level of benefits required in any plan to be sold on their exchange, though they'd still have to meet 10 general criteria listed in the federal law for essential benefits. If states don't set up their own exchanges and the federal government steps in, it would make that decision for the state, even to the point of specifying which insurers could sell plans on the exchange.
Tom Donovan, deputy insurance director, said the bulletin makes clear that states can choose to let the market drive their benchmark plans, essentially allowing any legally qualified insurer to sell its plan on the Idaho exchange. That's the approach the Idaho legislation takes.
Idaho State Insurance Director Bill Deal is presenting the draft legislation for a state health insurance exchange to the Legislature's joint Health Care Task Force; the room's about a third full, with lots of lobbyists in attendance. The nine-page bill includes an emergency clause, making it effective upon passage.
Among the questions from the lawmakers: Rep. Fred Wood, R-Burley, noted that federal law says a majority of the board overseeing the exchange can't come from the insurance industry. With the legislation specifying three carriers and three producers on the board, he said, that means the two lawmakers, who would be appointed to the board by the speaker and Senate president pro-tem, couldn't be “associated with the insurance industry,” he said. Deal confirmed that, saying, “Correct.”
The board would have 13 members, 11 of them voting. Nine would be appointed by the governor, with confirmation from the Senate. Those would include three representing different health carriers; two representing producers; one representing “individual consumer interests;” and three representing employers of varying sizes. The two non-voting members would be the directors of the state departments of Insurance and Health & Welfare.
A group of north Idaho political and business leaders agreed unanimously Wednesday that Idaho should avoid creating a state health insurance exchange and should instead wait for the U.S. Supreme Court to rule on the Obamacare lawsuit of which Idaho is a plaintiff. The leaders unanimously backed a resolution that says, in part, that “it is not in the best interest of the state for any state official to participate in planning or establishing health insurance exchanges as provided for in the federal Patient Protection and Affordable Care Act” and that Congress should “defund planning grants to the states for the establishment of PPACA health insurance exchanges by the states.” The resolution is signed by members of the major political groups in north Idaho including Tea Party, Pachyderm clubs, Reagan Republicans, United Conservatives of North Idaho, North Idaho Political Action Committee, Kootenai County Republicans and Kootenai County Republican Women/Wayne Hoffman, Idaho Freedom Foundation. More here.
Question: Do you agree with the North Idaho Republican groups re: the health care exchange?
During the state Legislature's Health Care Task Force discussion this morning on health insurance exchange legislation, Rep. Carlos Bilbao, R-Emmett, said he's visited lots of senior centers and nursing homes in his district in the past few months, and has found people there both concerned and confused about the exchange and what it would mean. State Department of Insurance Director Bill Deal responded, “First of all, if you're at your senior citizen centers, you're dealing with a different group of people.” People age 65 and over qualify for Medicare and aren't a part of the exchange. “The exchange goes up to (age) 64,” he said.
Task force Co-Chairman Rep. Gary Collins, R-Nampa, noted that for seniors, Senior Health Insurance Benefits Advisors, or SHIBA, offers guidance on how to navigate the various coverage options under Medicare; SHIBA's website at the state Department of Insurance says, “We offer free and unbiased information, counseling, and assistance regarding senior health insurance. We do not sell insurance, recommend policies, agents, or specific companies. It is our goal to provide you with up-to-date and objective information to assist you in making informed buying decisions.”
Deal said the idea under the proposed Idaho health insurance exchange is that uncompensated “navigators” would fill the same role for those ages 64 and under that SHIBA does for seniors with Medicare.
The Idaho Legislature's Health Care Task Force got a detailed rundown this morning from Bill Deal, director of the Idaho Department of Insurance, on the latest draft of legislation to establish a health insurance exchange in Idaho. Deal said the latest draft, from Dec. 9, has been developed by Gov. Butch Otter's health care council, a drafting committee from the Department of Insurance, and “innumerable recommendations that have come from people interested, and many of those have been incorporated.” The department also has been holding public meetings around the state on the plan; a recent one in Idaho Falls drew more than 60 people.
The plan envisions a resource for Idaho purchasers of individual and small employer health benefit plans, that would include listings of all the qualified plans available along with their costs and benefits, and uncompensated “navigators,” who could be anyone from chambers of commerce to unions, who could help purchasers sort through the various plans. The exchange would be overseen by a 13-member board, including three representatives of health insurance companies, two of insurance agents or “producers,” one of individual consumers, and three representing various sizes of small employers in Idaho. The governor would appoint the board. An advisory panel of providers, including physicians, pharmacists and so forth, would advise the board, and the board would designate at least one of its members as a liaison to the provider advisory committee.
Rep. John Rusche, D-Lewiston, said, “I think the advisory committee is a good approach.” But, he said, “I have had feedback from several people that the governance board seems to be very heavy with the insurance industry … (and) light on purchaser or citizen input.” Deal said the board will be an administrative body, and it'll be important for members to have management experience and know a lot about information technology, since the whole exchange will be tied to an online portal. The board, he said, won't be reviewing the financial stability or market conduct of insurance providers - that duty will remain where it is now, with the Department of Insurance.
The Health Care Task Force likely will meet again, possibly the first week of the legislative session, to review the final version of the legislation.
Seven states that are suing to overturn the national health care reform legislation are among 13 that today were awarded grants under the law, the Associated Press reports. Idaho is among the seven; the grants are for planning work to help set up state insurance exchanges. Three more plaintiff states in the lawsuit already got the grants. Click below for a full report from the AP in Washington, D.C.
The Health Care Task Force, a joint committee of seven state senators and seven state representatives, meets Tuesday starting at 9 a.m. at the state capitol, with an agenda that includes an update on the problems with the Molina system; the latest from the National Conference of State Legislatures on states' efforts to comply with national health care reform legislation; and both an update and a panel on the Idaho health insurance exchange, including information from state Insurance Director Bill Deal on where things stand, and opinions from 10 interested groups, from IACI and the American Cancer Society Cancer Action Network to the Idaho Chamber Alliance, the Idaho Association of Health Plans and the Idaho Freedom Foundation.
You can see the full agenda here, and listen live here.
The Idaho Association of Commerce & Industry, a lobbying group that represents the state's biggest businesses, has sent a letter to Gov. Butch Otter praising his decision to apply for federal grant funds to start an Idaho health insurance exchange, and laying out its ideas on how an exchange should work. In the letter, IACI President Alex LaBeau said the group's support for seeking the grant funds is “based on two very practical reasons: (1) to protect Idaho's citizens from higher taxes, and (2) to safeguard Idaho's ability to control its own destiny when developing an exchange, which we believe is a conceptually sound policy idea.”
He added, “Your wise decision gives Idaho control of its own destiny. By not requesting the grant money, Idaho would have lost its ability to work in the best interests of small business and individuals. The result of the loss of control would have dictated that Idaho be forced to turn over precious resources to the federal government, in the form of potentially higher taxes and fees, which would put an already delicate economy further in jeopardy.” You can read the full letter and proposal here.
Here's a link to my full story at spokesman.com on Gov. Butch Otter's decision today to give the go-ahead for Idaho to apply for nearly $31 million in federal grants to start an Idaho health insurance exchange. Otter remains a firm opponent of the national health care reform legislation that he dubs “Obamacare,” and the state is continuing to press its lawsuit seeking to overturn the law. But Otter said the idea of health insurance exchanges has been around since long before the legislation and was “co-opted” by the national law; he said Idaho's been looking into it since 2007.
Exchanges are envisioned as places or portals where people or small businesses could go to find health insurance they can purchase, see if they're eligible for federal subsidies, and compare costs and benefits. Plans offered on the exchanges would have to comply with guidelines. The state exchanges are a centerpiece of the national health care reform legislation; they'd be designed to let Americans who lack insurance get easier, more affordable access to it. In Idaho, 17 percent of residents lack insurance, but that figure soars to 31 percent for those age 18 to 34.
Idaho Gov. Butch Otter announced today that he's decided to allow the Idaho Department of Health & Welfare and the Idaho Department of Insurance to apply for federal grant funding to start an Idaho health insurance exchange. “It’s a difficult choice, but one I find far preferable to submitting to a federally established insurance exchange, with all the loss of control over our own destiny that entails,” Otter said. He said the exchange will be designed to make health coverage more accessible and affordable for Idahoans; click below for his full announcement.
The Idaho House Health & Welfare Committee has scheduled an interim meeting for Sept. 29. to talk about health insurance exchanges. The meeting will from from 8-10 a.m. in the Capitol Auditorium; the committee is also inviting members of the Senate Health & Welfare Committee, the House Business Committee, the House and Senate commerce committees, other interested legislators and the public to attend. The group will hear an overview of other states' efforts to establish exchanges, an update on Idaho's proposed approach, and a presentation from the Heritage Foundation. A full agenda will be posted at the Legislature's website.
Gov. Butch Otter is winning praise today for his pitch to lawmakers yesterday about the importance of setting up a state-run health insurance exchange, rather than letting the federal government come in and set up and run an exchange for Idaho. Jim Wordelman, state director of the Idaho AARP, said, “The creation of the exchange would allow individuals, families and small businesses to find affordable health care by giving them the same advantages large companies have when they negotiate group rates. AARP strongly supports the implementation of a state driven approach to the exchange with strong consumer protections and commends Governor Otter for his stand.” You can read the AARP's full statement here. Also today, the Idaho Associated General Contractors sent out this tweet: “Idaho AGC commends Governor Otter for being a responsible leader on health care exchanges.” You can read my print story here from today's Spokesman-Review.
You can read my full story here at spokesman.com on Gov. Butch Otter's pitch to state lawmakers today for the state to apply for a $40 million federal grant to set up its own health insurance exchange - to avoid the feds stepping in and doing it for the state - and the supportive response from lawmakers, including some who are leery of any participation in national health care reforms. The state has to apply for the grant by Sept. 30; it could decide later to return some or all of the money with no penalty, Otter said.
Lawmakers on the joint Health Care Task Force say they're supportive of Gov. Butch Otter's strong pitch to them this morning for Idaho to apply for a $40 million grant to set up its own state health insurance exchange; if Idaho doesn't create an exchange, the federal government will step in with its own. “We should not be wasting any time,” said Sen. Joe Stegner, R-Lewiston. “There's no risk,” said Sen. Dean Cameron, R-Rupert. “The risk is in not applying, and then turning the individual and small group market over to the federal government.” Stegner added, “We're going to be extremely short-sighted if we let this opportunity pass.”
Rep. Janice McGeachin, R-Idaho Falls, the House Health & Welfare Committee chairwoman, said, “We can go forward and establish our own exchange, and I think we should. It's my sense that we probably should consider applying for the grant.” However, McGeachin said she's still not convinced that Idaho couldn't later decide not to spend the federal money, and fund an exchange with state funds; she said she wonders if it couldn't be done for less. “Our country's going broke,” McGeachin said. “We just need to be sure no matter where the money's coming from, that we're spending it appropriately. Those questions for me need to be answered.”
Sen. John Goedde, R-Coeur d'Alene, said, “I think I could support … the use of the federal money to design an Idaho exchange. What I've not understood yet are what kinds of strings are attached to that decision. When we're having a tough time finding money to pay our part of Medicaid claims, I think $40 million is unrealistic in state money for development of the exchange. The key is if there are more strings we haven't heard about to the federal money.”
House Minority Leader John Rusche, D-Lewiston, said, “To me it's a no-brainer.” He added, “It's unfortunate that the Legislature kind of painted itself into a corner by not only saying 'no,' but 'hell, no.' Now they're going to have to, I hope, look at what's best for the citizens of Idaho, not only for political posturing.”
Idaho lawmakers this year passed legislation aimed at opting the state out of complying with portions of the national health care reform legislation, after first considering several measures aimed at attempting to “nullify” the federal law. Otter vetoed the bill, but imposed an executive order instead banning Idaho from accepting any federal money under the federal health care reform law unless he personally approves a waiver. So far, he said, he's approved 10 of the 13 waivers state agencies have requested, mostly for grant programs unrelated to health care reform whose funding now falls under the bill; he needs only issue another waiver to approve the grant application before the Sept. 30 deadline.
If Idaho went with a federal health insurance exchange, rather than starting its own, state Insurance Director Bill Deal said as many as 2,500 Idaho insurance agents who are licensed for health and life insurance only could go out of business. “I think there would be no question that agents would probably not be needed in the exchange, using the federal concept,” Deal told lawmakers. “I think it would be a definite economic disaster from the standpoint of more unemployment,” he said. Plus, he said, “If a federal exchange would come in, likely there would be a national carrier involved in that.” Idaho companies would lose market share, he said, “which would result in a loss of premium tax.”
Idaho Department of Insurance Director Bill Deal said Idaho is one of 12 states that have had no legislative action to date to establish a health insurance exchange. Meanwhile, 13 states have enacted such legislation, including Washington, Oregon, Nevada, Utah, California, Colorado and California. There's a January 2014 deadline to have the exchange up and running and certified, Deal said. “If Idaho does not have that exchange in place, then we … are going to be provided that exchange coverage through the federal government, which many of us don't think that's the best plan,” he told the Legislature's Health Care Task Force this morning.
As far as how much it'll cost to set up an exchange, Deal said the state of Washington estimates it'll cost $99 million from 2011 to 2013; Kansas estimates $62 million over two years; and Wisconsin estimates $49.5 million from 2010 to 2013. “If Idaho does not demonstrate that it is … ready to run an exchange, the federal government will impose and run an exchange in Idaho,” Deal said. “My personal view of this … it's going to be very disruptive to the Idaho marketplace and particularly with our domestic insurance companies and our agents, and that's a big issue. And also, the other part that is just as concerning to me, that the regulation of the health insurance industry in Idaho will not be state-based but without question, the federal government's going to dictate the policies that are followed here in Idaho with health insurance.”
He said, “We do have some options. … We can submit that grant application. … It does not lock Idaho in. … Securing the grant allows Idaho time to make the decision, we have the money, we can continue to move forward. … If something comes along, we can take that exit strategy. … This gives us time to wait for the lawmakers to decide options for the Idaho exchange.” He added, “In my view, time is the enemy.”
In Idaho in 2010, 31 percent of people age 18 to 34 had no health insurance, state Department of Health & Welfare Director Dick Armstrong told lawmakers this morning. Overall 17 percent of Idahoans lack insurance, but years of rising costs have pushed the healthiest population - the 18-to-34-year-olds - to drop insurance. The number now, he said, is “strikingly high.” That means, Armstrong said, “An individual without insurance then has limited access to health care services, which results in a diminished quality of life.” Plus, as insurance increasingly covers only the sickest people, costs rise. “We all know the current system is unsustainable,” he told the Idaho Legislature's Health Care Task Force.
The national health care reform legislation includes an array of changes, including 41 programs, 10 of which became law in 2010 and were implemented, and another eight of which are taking effect in 2011. Among those that took effect in 2010: Raising the age limit for dependents to be covered on their parents' health insurances, coverage of pre-existing conditions for children, regulation of lifetime benefit limits and coverage of preventive services. “Many of you are already seeing or have taken advantage of some of those changes,” Armstrong said, noting that he has, as the parent of a 26-year-old.
The health insurance exchange idea, Armstrong said, “As the governor mentioned, is not a new idea. It was first a product of the Reagan Administration. It's been around.” The idea, he said is “to allow businesses to pool together, like large self-insurance customers have done for years, because from a risk standpoint, the more people that are insured the better the risk and the more stable the rates will be. … You actually are able to spread the fixed costs over more citizens in Idaho.”
Idaho Gov. Butch Otter told the Legislature's Health Care Task Force this morning that Idaho has been working on the idea of a health insurance exchange since 2007, and “That idea I believe was co-opted by Obamacare.” In fact, he said, “We find that many of the things we were doing in Medicare, many of the things we were doing in health care services for children adults, from Medicaid services to dentistry, have been co-opted by the Affordable Health Care Act.” That's why, he said, he's issued waivers for 10 of the 13 requests he's received from the state Department of Insurance and the state Department of Health & Welfare under his executive order that forbids accepting any federal health-care reform money without his personal approval for a waiver.
Otter said Idaho is “at a crossroads,” at which it must decide - by Sept. 30 - whether or not to apply for a $40 million federal grant to build a new Idaho state insurance exchange. “If we do not apply for the grant, then under the Affordable Health Care Act, the federal government will come in and establish and impose upon us … an insurance exchange.” It would make use of national insurance firms, he said - not Idaho companies. “The date of Sept. 30 is coming at us at a rapid rate,” Otter told House and Senate members who serve on the joint task force. “What's the state going to look like in terms of our health care exchange? … Should we decide not to go for the $40 million grant, and let the federal government then assume responsibility for the health care exchange within the state of Idaho?”
House Health & Welfare Chairwoman Janice McGeachin, R-Idaho Falls, asked if Idaho couldn't set up its own exchange without taking the federal money. Otter said that's possible, but there'd be a cost. He also noted that Idaho could apply for and receive the grant, and then - as Kansas and Oklahoma already have done - decide to return part of it rather than comply with regulations attached to the money, without having to pay back any portion already spent. “We can stop - return the money and we're not required to return any of the money that we've already spent,” Otter said.
John Stucke reports on Washington state’s new health insurance exchange, which is designed to help upward of 50,000 small businesses attain health insurance for their employees. As with many things linked to the federal Affordable Care Act, the exchange is controversial, untested, and the financial risks unknown.
Columnist Bert Caldwell writes about the Lilac Bloomsday Association and race director Don Kardong. “The association’s business model is a marvel of economy,” Bert says.