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Red State Idaho Embraces Obamacare Insurance Exchange -- Reluctantly

WebMD News from Kaiser Health News

By Phil Galewitz

Wed, Aug 07 2013

EAGLE, Idaho — On Election Night, Bill McCarrel Jr. watched teary-eyed residents crowd into his historic bar, The Gathering Place, after President Barack Obama won a second term. His customers worried aloud about losing access to their guns and having to accept the federal health law that many revile as socialized medicine.

Like most people in this fiercely Republican state, McCarrel opposes Obamacare -- even though he's uninsured and can’t find affordable coverage as a result of his artificial hip and knees. But the former junior high principal is looking forward to shopping on the Obamacare online insurance exchange starting in October to see if he can get a plan he could afford. 

McCarrel, 55, is thankful the Idaho legislature -- prodded by Gov. C.L. "Butch" Otter and powerful employer groups -- decided to have the state operate the exchange rather than leave it to the federal government. "People in Idaho don't trust the state government, but they trust Washington D.C. even less," he says in his spacious bar housed in a former drugstore built in 1906.

Of the 16 states that are gearing up to operate their own online marketplaces -- a central feature of the effort to expand coverage to millions of people starting in January -- Idaho is the only one where Republicans are in total control of state government. Republicans outnumber Democrats 4 to 1 in the state Legislature and only a third of Idahoans voted for Obama last fall – the third lowest tally nationwide.

Nonetheless, employers and Otter, staunch opponents of the law, were able to convince tea party activists and other critics that having the state run the marketplace where individuals and small businesses shop for coverage could result in less expensive premiums -- and keep control in Boise.

"In Idaho, people have a fierce resolve to do things themselves. … We want to prevent ceding any more control to the federal government than is necessary," says Otter, who  credits business leaders -- along with hospitals, insurers and other stakeholders -- for putting pressure on legislators to approve a state marketplace.

Alex LaBeau, president of the Idaho Association of Commerce & Industry, the state's most influential business lobby, argued the state could better control costs, offer more choice and preserve the role of agents and brokers. 

His group helped elect more than a dozen new "business-friendly" state legislators who supported a state-run marketplace, also called an exchange.

"The business community always prefers to work with state government as our state agencies always pick up the phone when we call," LaBeau says.

As Idaho races to launch its exchange this fall, the state will face the added challenge of trying to persuade a citizenry known for its anti-government leanings. Exchange officials are hopeful an education campaign using direct mail, billboards, churches and websites like Facebook and Twitter, among other things, can help them overcome doubts about participating.

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