BOISE, Idaho (CN) - The Idaho Senate approved Gov. Butch Otter's bill creating a state-run health insurance exchange, sending the legislative session's defining issue to the state House.
The Friday vote on Senate Bill 1042 came as a surprise to those who expected heavily Republican Idaho to follow Oklahoma's example and fight to the end over President Obama's health care mandate.
The bill, however, passed by a 23-12 vote after a six-hour debate. But Idaho senators cited concerns that have plagued them ever since the U.S. Supreme Court ruled that the federal government has the right to tax people and businesses that do not comply with the federal health care mandate.
Otter's bill provides the architecture for a state-run exchange under the Patient Protection and Affordable Care Act, aka Obamacare, enacted by Congress in March 2010, and upheld by a 5-4 vote of the Supreme Court before the November 2012 election.
States have until January 2014 to implement the federal plan or their own health exchange. Some states are scrambling to write their own plan, some debating whether to default to a federally run exchange, and others whether to do either one.
In Boise, members of the Senate Commerce and Human Resources Committee fielded public comments on Feb. 5 and 7. Some senators were visibly conflicted by their vote for a state exchange. But they apparently feared the consequences of failing to comply with the federal law.
"I deeply despise Obamacare," said state Sen. Todd Lakey, R-Nampa.
"I'm frustrated with the position we are in and that the rules keep changing, but I also feel I have a responsibility to Idaho."
Other senators agreed that a state-run program would give Idaho some control over the exchange.
The Senate committee consists of 7 Republicans and just 2 Democrats, including Sen. Branden Durst, D-Boise, who was the dissenting vote in the committee's 8-1 vote to send the legislation to the full Senate with a "do pass" recommendation.
In addition to concerns about intrusions on state sovereignty, another key hurdle for Idaho politicians is that the state exchange would be run by an independent board, and not subject to legislative oversight.
"Just so that we have this straight: there will be no legislative oversight with a state exchange?" Sen. Durst asked Otter's Chief of Staff David Hensley at the Feb. 7 committee hearing.
"You will have a say as it is being created, but after that, no, no there will not," Hensley said.
Idaho Republican Party Chairman Barry Peterson said in a statement before the Feb. 5 hearing: "Remember, the Idaho State Legislature passed the 'Idaho Health Care Freedom Act' in 2010, opposing any and all Obama health care programs. We wholeheartedly accept and support that law. If Idaho's Republican lawmakers decide to embrace Obamacare, Idaho will be making it difficult for other states to continue their resistance."
Hensley said at the conclusion of the hearing that he had been told by the Idaho Attorney General's office that a state health exchange would not violate the Idaho Health Freedom Act of 2010.
In the Idaho House
On Feb. 13 lawmakers in Idaho's lower house unveiled H.B. 179, responding to the lack of legislative oversight of the state exchange. H.B. is a companion bill to what opponents call "Ottercare," S.B. 1042.
House Bill 179 would put two lawmakers on the exchange's 18-member governing board, as nonvoting members.