Gov. Butch Otter contends that creating a state-based nonprofit insurance exchange will result in a marketplace for individuals and small businesses to compare and buy insurance that's less expensive and friendlier to Idaho insurers and agents than what Washington, D.C., would come up with.
Many Republicans were torn, given that they oppose President Barack Obama's insurance overhaul, which requires that every state has an exchange. Many Republican-led states are choosing to default to an exchange run by the federal government.
But GOP Sen. John Tippets of Montpelier argued Idaho, not the federal government, should be in control because an insurance exchange - state or federal - is a virtual certainty come 2014.
"The facts are, we will have a health insurance exchange of some type," Tippets said. "The Department of Insurance anticipates there will be dozens of plans offered through the (state) exchange. That may not be the case with a federal exchange."
Six of seven Senate Democrats backed the measure, which would set up a nonprofit organization with an independent, governor-appointed board to run the exchange. Some took issue with Republicans' criticism of Obama's ambitious 2010 bid to address problems in America's health care system.
"I'm here to tell you, as another voice, I support my president, and I support 'Obamacare,' " said Sen. Les Bock, D-Boise.
Otter's office estimates running a state exchange would cost about $10 million a year, or $58 annually for each of Idaho's roughly 177,000 residents expected to use it. A federal exchange could be more than $150 per person annually, or three times the state rate, Otter has said.
But opponents, including GOP Sens. Steve Thayn of Emmett and Monty Pearce of New Plymouth, insisted such figures remain a dangerous cipher.
Barring certainty, Idaho should join about two dozen other states like Georgia, Oklahoma and Texas that have opted for the federal version, they argue.
"We're in the dark. We don't really know where we're going. We think we do. We've been told all kinds of figures," Pearce said Thursday, arguing this is really just another federal intrusion. "Why would we bring the feds into our state, and invite them to run health care?"
Other foes cited a symbolic vote for Idaho's sovereignty. Sen. Curt McKenzie, R-Nampa, said his fierce opposition to the Patient Protection and Affordable Care Act was such that he couldn't in good conscience lend his voice to even part of it.
"When the federal government oversteps its bounds, I have a duty to resist that within the constitutional powers I have," McKenzie said.
But backers said such a view, while emotionally satisfying, was unconstitutional, given the U.S. Supreme Court has ruled Obama's overhaul was legal, including its "individual mandate" requiring people to buy insurance or face fines.
Sen. Dean Cameron, R-Rupert, described how a man approached him after a committee vote on the bill and told him Idaho wasn't limited either to a federal or state exchange.
The man insisted on a third path: rebellion.
"That's really not a choice," Cameron countered Thursday. "I don't believe it's my prerogative to choose which provisions of law are constitutional or not."
Sen. Dean Cameron, R-Rupert: "The exchange is nothing more than a website. It's not the agent of the federal government. It will not be implementing or enforcing the Affordable Care Act. The carriers are asking for it. ... They're trying to survive."
Sen. Jim Rice, R-Caldwell: "This is an area where we have no ability to win but we have some ability to defend our citizens. They elected us to defend them. They elected us to protect their rights in the ways that make the most sense, the ways that are most effective, in the ways that most work."
Sen. Bart Davis, R-Idaho Falls: "If Idaho does nothing, federal regulators will exclusively build Idaho's health care system. ... If Idahoans cede an exchange to the federal government, the next step to a single-payer system is easier."
Sen. Marv Hagedorn, R-Meridian: "I'm so frustrated, as many of us in this room are, that Obamacare is law in the first place. ... I can't ride this pig if it's a federal exchange. I can ride it with spurs on if it's a state exchange."
Sen. Monty Pearce, R-New Plymouth: "Liberty is the right to choose. Freedom is the result of a right choice. ... Folks, this is Idaho."
Sen. Russ Fulcher, R-Meridian: "There are ramifications to voluntarily complying. In my opinion, this is going to be litigated for decades. Once we comply, once we take their money, we're in a poorer position to litigate."