Tate and Beth Mason of Boise had a very personal reason to vote for Barack Obama on Tuesday.

Beth, 34, came down with an acute form of encephalitis, a brain infection and inflammation that forced her to leave her job as a social worker. Blue Cross turned her down for health insurance because of her pre-existing condition. She ran up bills of $250,000.

When Obama’s Affordable Care Act passed, she got insurance from its Pre-existing Condition Insurance Plan. His re-election means she will be able to keep it, she said.

“If we can’t get insurance, we’re facing a life of poverty,” said Tate Mason, a graduate student.

Obama’s win means that Obamacare moves forward, and with it coverage for as many as 260,000 uninsured Idahoans.

“The Legislature can no longer ignore it and hope it will go away,” said House Minority Leader John Rusche, D-Lewiston, a former physician.

A Blue Cross of Idaho spokeswoman said the company does not turn down people for insurance.

“Blue Cross of Idaho must by law offer alternative coverage to every individual who is not eligible for its coverage plans," said Karen Early of Blue Cross. "If an individual is not eligible for the company’s regular coverage plans, Blue Cross of Idaho offers High Risk Pool coverage, which it administers on behalf of the State of Idaho.”

Idaho and other states failed to stop the law that is already transforming health care delivery in Idaho. Lawmakers also refused federal funds to implement the law and sought to prevent the state from creating a state exchange that would allow consumers to compare prices and buy insurance, with subsidies based on income.

Gov. Butch Otter’s 13-member health exchange working group last month recommended that Idaho pursue a state-based exchange for 2014. Otter has the power to establish an exchange with the stroke of a pen, but must submit a blueprint to the federal government by Nov. 16.

Otter told the Statesman on Tuesday night that he has not made a decision. But overall he expressed disappointment that Mitt Romney fell short.

“The only relief I can see is a majority in the House,” the governor said.

Lawmakers have to decide whether to accept an expansion of Medicaid that is a part of the law, which could provide coverage to the 83,000 to 138,000 Idaho residents who would qualify under the program.

Rusche said he expects Congress to pass changes to make the health care program work better. But even had Obama lost, he said, national health care reform is here to stay.

“The health care system is making the changes, whether the Legislature wants them to or not,” Rusche said.

Pat Sullivan worked on the staff of former U.S. Sen. James McClure, R-Idaho, and is now a prominent lobbyist. He expects pragmatism in Idaho.

“I think the state Legislature is going to be working overtime to get a state health exchange in place,” he said.

IDAHO AND THE DEFICIT REALITY

Congress will soon return to Washington, D.C., to address what has been called the “fiscal cliff.” It will have to decide whether to change $1.2 trillion in budget cuts — including deep reductions in defense spending — and decide on Bush-era tax cuts and other budget and tax issues by the end of the year.

Obama’s re-election will force Republicans to “cave” on the fiscal cliff, said Idaho Democratic Party Chairman Larry Grant. He expects a budget and tax deal that will include “an increase in taxes for the wealthy.”

Republican Sen. Mike Crapo of Idaho is one of the “Gang of Six” senators from both parties working on a deal like the balanced proposal put forth by Obama’s Bowles-Simpson Commission, on which he served. He’s been joined by Republican Rep. Mike Simpson, who is pushing a plan of spending cuts and increased revenue to trim the deficit by $4 trillion.

Both plans call for lowering tax rates and eliminating tax breaks to increase revenues.

All sides acknowledge a need to cut the federal budget deficit. That will reach deep into Idaho’s economy.

Idaho gets more in federal spending than its citizens pay in federal taxes. From 1990 to 2009, the federal government spent $148.4 billion in Idaho, according to the Economist magazine. In the same 20 years, the federal government collected $124.3 billion in taxes from Idahoans.

That left the state with a $24.1 billion windfall that contributed to its $53.7 billion gross domestic product in 2009. Federal stimulus money brought another $1.5 billion worth of roads, energy projects, waste cleanup at the Idaho National Laboratory and more that year.

INL, MOUNTAIN HOME

Nowhere will federal budget cuts be more apparent than at the Idaho National Lab, which generates $3.5 billion in economic activity and creates 24,000 jobs, mostly in eastern Idaho. INL has begun cutting staff, and that will continue.

Mountain Home Air Force Base generates more than $1 billion annually and creates 7,000 jobs; observers are watching how proposed cuts by Congress could affect the base.

How Idaho — including the INL — fares will depend largely on Simpson, who is a subcommittee chairman on the powerful House Appropriations Committee. Simpson was holding a comfortable lead in early resorts over Democratic challenger Nicole LeFavour.

PUBLIC LANDS, ENVIRONMENT

Obama’s re-election is not expected to bring much change to public land and resource issues that once were central to Idaho’s economy.

Interior Secretary Ken Salazar has built good relationships with Otter and Simpson, who has a major influence on his budget. From wolves to forest fires, the Obama administration has worked closely with western Republicans to carry out similar goals. That’s a change from a testier relationship with the previous Democrat in the White House.

“He’s not (Bill) Clinton,” said Phil Reberger, a former chief of staff to Republican Gov. and Sen. Dirk Kempthorne and GOP Sen. Steve Symms.

Obama needed western states like Colorado, New Mexico and Nevada to bolster his re-election bid. A second-term president has a different outlook, said Rick Johnson, executive director of the Idaho Conservation League.

“The word legacy comes up,” Johnson said.

That means he could follow the example of Clinton and identify areas that warrant protection under the Antiquities Act of 1906. Clinton used that law to expand Craters of the Moon National Monument.

Former Idaho Gov. Cecil Andrus, who convinced President Jimmy Carter to designated millions of acres in Alaska as a national monument, has asked Obama to set aside the Boulder-White Clouds area under monument status.

Obama’s clean-energy initiative will continue, said Sierra Club political director Bill Arthur, who expects climate change and environmental protection to get a higher priority.

“I think in a second term we will see a less conservative and a more energized administration than we saw from the Obama administration in the first term,” Arthur said.

Rocky Barker: 377-6484