Insurance exchange sparks healthy debate

COEUR d'ALENE - Around 200 people packed the Coeur d'Alene Public Library on Saturday to listen to, question, praise and scold North Idaho legislators.

The weekend town hall was held to update the public on what legislators are working on while they're in Boise during the session, but one topic - whether Idaho should adopt a state health insurance exchange - dominated the discussion as lawmakers are on the cusp of doing so.

A state exchange seems likely after 16 GOP freshman pledged their support for the governor's bill to establish one that helped it pass the Senate last week.

Newly-elected Rep. Luke Malek of Coeur d'Alene organized the freshmen support, and explained his reasoning Saturday to a divided crowd.

"It will be a part of our insurance landscape. Period," Malek said of President Barack Obama's Affordable Care Act, commonly known as "Obamacare." "If we do it now, the feds have to pay."

The state could hold off doing anything, he added, but that would be the same as accepting the federal exchange.

Under the new national law, states can choose to set up their own exchanges, which are Internet portals where residents can shop for insurance and access federal subsidies. If the states don't, the federal government will run the exchanges instead.

If Idaho acts quickly and establishes its own exchange, Malek said, the federal government would pay more than $20 million to get it up and running. But that deal expires in about a year. If Idaho wants to establish a state exchange in the future, that money wouldn't be there.

The idea of relying on federal money drew laughs and scoffs from some members in the audience, which was predominantly Republican.

"It's almost unpatriotic, I would think," said Gary Ingram, a former legislator, of accepting federal money for the program. "The government is not one you can trust at this point in time."

Representatives Ron Mendive, Vito Barbieri, and Kathy Sims said they didn't support the state exchange, nor did Sen. Bob Nonini and Sen. Steve Vick.

Barbieri, R-Dalton Gardens, and Nonini, of Post Falls, called the freshmen who supported the state exchange the "gang of 16." Both said a state exchange would be financially costly for the state, and the federal government has to sign off on the exchange, meaning it's a federal program anyway.

"In their hearts they're doing the right thing," Nonini said of state exchange supporters, like Malek and Sen. John Goedde, who was also on hand. "But in their minds they're not."

Some in the audience said the state shouldn't do anything. Not acting would be fighting the federal government. The U.S. Supreme Court determined the health care law is constitutional and Obama was easily re-elected in November, in part because of his success getting the landmark legislation passed.

"This issue is: Are we going to fight for liberty?" Jeff Ward, chair of a local Republican political group, asked the legislators. Or does the state instead plan to succumb to "tyranny," he asked.

The 16 GOP freshmen pledged support of Gov. Butch Otter's bill if their own bill that would require more legislative oversight of the exchange first passes both the House and Senate, according to reports. That portion is scheduled for a House committee hearing Monday.

Mendive, R-Coeur d'Alene, said it's important to fight the federal law.

"It's all about taking away our freedom," he said, which drew applause. "It has nothing to do with health care. Also, on federal money - there's no such thing."

Even the state exchange supporters don't like the health care law, Rep. Ed Morse said, but they are choosing the lesser of two evils. If a state exchange proves unsuccessful, Idaho can always opt to the federal program.

Rob Moser, who lives in Post Falls, handed out signs against the state exchange before the two-hour meeting, which the audience waved at times.

"Can you think of one time where the feds did it better than the state?" Goedde asked as the signs waved.

After the Coeur d'Alene Senator likened the decision to getting run over by a truck or walking along beside it, attendee Sharon Hebert referenced that example to the Holocaust.

"I think that's what the Jews did," she told the legislators.

"They still got to their destination," she added.

Other legislative issues came up, but didn't receive near the attention the state exchange did.

Sims told a story of an older Canadian whom she knew who was told by Canadian doctors there wasn't medical help after the person had a stroke. The Canadian sought another opinion in a private practice, and was treated and is healthy today.

"Yes, the government can make decisions whether you live or die," she said. "And as you get older, that's something you think about."

When John Cross told Malek he could no longer support Malek's political career as a result of the freshman's state exchange stance, Malek said: "I'm honored, honored to have this seat, but I'm not going to sacrifice my principals."