In the late ‘80s, political journalist Randy Stapilus penned a book about the dichotomy of Idaho politics and called it, Paradox Politics. At the time, it focused on such Idaho political dilemmas as how a Libertarian-leaning Republican U.S. Senator like Steve Symms could be embraced by the same electorate that loved a Democratic governor like Cecil Andrus.
Fast forward 25 years and Idaho politics are not nearly as diverse and colorful as they were back then, but a paradox remains. Our Libertarian-leaning governor, Butch Otter, one of the first in the country to sign onto a lawsuit against President Obama’s health care reform law, is now a bit of a champion of one of the law’s requirements – the insurance exchange.
In a Dec. 29 press release, the governor made the case that an “Idaho health insurance exchange makes sense” if Idaho is in control. He encouraged lawmakers to take up the issue. In fact, he argued Idaho was already considering an exchange before the Patient Protection and Affordable Care Act required it. In his Jan. 9 State of the State address, he was a little tamer but his argument is essentially this: If Idaho does not act proactively to establish these exchanges, the feds will do it for us – and that is an alternative our good governor is anxious to avoid.
So, what exactly is an exchange?
Essentially, an exchange is intended to fix employer costs and simplify health plan administration. Our neighbor to the south, Utah, has had an exchange in place since 2009. Within a month of its implementation, Utah exceeded its enrollment goal with 136 employers enrolling and a total of 2,333 employees.
In Utah, it appears to be creating an affordable model for small businesses that especially struggle with health care costs. A survey of Utah small employers showed only 40 percent were able to afford to offer health insurance and, of those, as many as 79 percent said they were having a tough time paying for it.
Under Utah’s exchange, employers can contribute a certain fixed-dollar amount to a person’s health insurance, enabling them to avoid unexpected spikes in costs. It’s also easy for employers because once they customize their contribution for each individual they send one check once a month to the exchange administrator.
When employees sign up, they go online and choose from 15 different plans from a website that works much like a travel website. They can view and compare information on not only the plan costs, but also the quality of the plans.
Costs are transparent, and industry insiders believe that will lead to insurance companies working harder to control administrative and other controllable costs. Until this year, only small employers with two to 50 employees could participate in the Utah exchange, as well as individuals and families who don’t get insurance from an employer. Larger companies will get their first shot at Utah’s exchange this year.
Insurance reform watchers say the Utah model is one for individual states to keep an eye on. Whether Otter is eyeballing Utah’s exchange is not clear. What is clear is that he wants to see lawmakers take on the task of implementing an Idaho exchange, using federal grants, even if it seems a bit of a paradox for Idahoans.
Many bought into the governor’s opposition of anything to do with Obama’s health care reform law. Can they, and the lawmakers who represent them, be flexible enough to allow that same law to provide funds to set up the exchanges? If not, as the federal law stands now, the exchange will happen anyway – but Idaho will have a lot less control over it.
Michelle Hicks is a communications consultant with Buck Consultants.