With the impending federal deadline for a decision on creating an insurance exchange, your Legislature now faces a difficult choice. We can either create an Idaho state exchange or let the federal government install one. At first blush, it might seem that creating an Idaho exchange will allow us to have more flexibility and control. However, that is not necessarily the case.
Nineteen states (as of Friday) have rejected creating a state insurance exchange. The governors of these states have been quite clear about the implications of creating an exchange. In fact, our own governor issued an executive order stating, “No executive branch department, agency, institution or employee of the state shall provide assistance or resources of any kind to any agency, public official, employee or agent of the federal government to implement or enforce the PPACA (Obamacare).”
Why are these states rejecting state insurance exchanges? The first is cost. The costs are large and will undoubtedly grow. Federal subsidy dollars will become increasingly scarce as the nation deals with a massive unsustainable deficit. All federal subsidies for the state insurance exchanges will cease by 2015, leaving the taxpayers of Idaho to pay for the exchange. Unlike Washington, D.C., Idaho’s Constitution mandates that the Legislature balance the budget, and budgeting for Obamacare is simply not possible, which brings up the second objection, uncertainty.
Uncertainty has been a hallmark of Obamacare from the beginning. Former Speaker of the House Nancy Pelosi, D-Calif., famously told us that to find out what is in the bill, they would have to first pass it. Well, we still don’t really know what is in it. Many key parts of the bill are not spelled out. Details are to be provided by decrees from the secretary of Health and Human Services, details which can change at any time with no congressional approval required. HHS regulations on the formation of state exchanges use the word “shall” 381 times, “must” 13 times, and “requirement” over 200 times. These edicts will supposedly trump any acts of state legislatures.
Many other state officials share my deep concerns. Gov. Chris Christie of New Jersey well understands the “blank check” a state insurance exchange represents, and last week vetoed a bill to implement a state exchange, stating: “I will not ask New Jerseyans to commit today to a state-based exchange when the federal government cannot tell us what it will cost, how that cost compares to other options and how much control they will give the states over this option that comes at the cost of our state’s taxpayers.”
Gov. Rick Perry of Texas said, “It is clear there is no such thing as a state exchange. Instead, this is a federally mandated exchange with rules dictated by Washington.”
These are serious concerns that must be addressed before we can commit to any kind of an insurance exchange.
When the Democratic Congress passed Obamacare in 2010, the Legislature passed and Gov. Otter signed the Idaho Health Care Freedom Act. At the time, Gov. Otter proclaimed: “What the Idaho Health Care Freedom Act says is that the citizens of our state won’t be subject to another federal mandate or turn over another part of their life to government control.” That was well said, and I will continue to stand with anyone willing to preserve freedom.
With all the costs and uncertainty, not to mention the fiscal cliff faced by the nation, why not let the feds establish this exchange and see how or if it works? Let’s not buy a pig in a poke. It’s good business sense and good government sense to wait and see how it all works out.
Mike Moyle is a state representative from Star and the majority leader of the Idaho House of Representatives.