The Idaho Legislature’s health care task force donned its waders one day in late July. One month after the Supreme Court’s landmark ruling upholding the Affordable Care Act, lawmakers decided it was time to take up the many questions surrounding the extent to which Idaho will carry out the law.

For states — especially those where opposition to the law runs high — the ruling raised two main questions: Will the state establish its own health insurance exchange, and will it decide to expand Medicaid eligibility as prescribed under the act?

Let’s take it question by question, and break down the highlights from the lawmakers’ discussion. First, the health insurance exchange. This is the so-called online marketplace that will allow consumers to view their health insurance options by costs and benefits.

We still don’t know what a federal exchange implemented in Idaho would look like, Joy Wilson of the National Conference of State Legislatures confirmed.

By Sept. 30, the state must establish the minimum essential benefits that must be offered by participating insurers. That’s a deadline the Idaho Department of Insurance is prepared to meet.

Come November, the state will have its next opportunity to apply for a federal grant to help cover the costs to establish the exchange.

There is a possibility of establishing an exchange that’s a federal-state partnership. The federal government might oversee the website and answering service center, Department of Insurance Director Bill Deal says, while the state oversees plan management.

Each November, states will have a chance to declare their intent to change their health insurance exchange plans. Deal says many states are considering the federal-state partnership as a way to get their exchanges up and running.

Now, the Medicaid expansion.

The Supreme Court’s ruling gives states a choice about whether to expand their Medicaid programs. The federal government would initially cover 100 percent of the cost of expansion, phased down to 90 percent by 2020.

It’s not clear what the Medicaid expansion would mean for the state budget. Department of Health and Welfare Director Richard Armstrong says the state has consultants looking into that question.

A key concern is what’s called woodworking. Idaho has historically had a large number of people who are Medicaid-eligible but are not enrolled. If an adult enrolls in Medicaid under the expanded program, and that person has children, the children will also automatically be enrolled. Because those children would have been eligible in the absence of the expansion, the federal-state cost split will be 70–30 for their coverage, as it is for other Idahoans already on Medicaid.

If the state opts into the expansion, the Department of Health and Welfare can establish a distinct and basic benefit plan for those who become eligible. Armstrong says the department intends to do that.

The overarching question about all of this is how the state will arrive at a course of action.

Gov. Butch Otter has established two working groups, which began meeting this month. By all accounts, he does not intend to convene a special session of the Legislature. Given that many decisions must be made before legislators come back to town in January for their annual session, it is left to Otter to make a “nonbinding declaration,” as Deal terms it.

Sen. Dan Schmidt , D-Moscow, asked Brian Kane, the assistant chief deputy of the Idaho attorney general’s office would happen if the governor and the Legislature are at odds.

“That would be a really legally interesting situation,” Kane said, pausing for emphasis. “I don’t know that there’s an answer to that at this point.”

Contact Molly Messick at mmessick@stateimpact.org.