Today, Idaho Gov. Butch Otter signed the law creating a state health insurance exchange. The Idaho Legislature approved the exchange earlier this month.
The Patient Protection and Affordable Care Act, the federal health care reform bill, was signed into law in March of 2010. The law required that insurance exchanges be established and provided options to the states of having the feds run it, having the states run it, or having a federal-state partnership. Idaho and 25 other states challenged the constitutionality of the law, and the United States Supreme Court, the highest court in the land, determined that most portions of the law, including the requirement for insurance exchanges, were constitutional.
The question is not, and has not been, whether Idaho should have an insurance exchange. The Constitution provides that this law is binding upon the states, so our choice was whether to have the federal government implement and operate the exchange, whether Idaho should implement and operate the exchange, or whether we should do it together.
I have written on many occasions here in this space and in the Idaho Statesman about what an insurance exchange is, and so I won’t revisit that now. St. Luke’s has supported the state-based exchange so as to maintain the maximum amount of flexibility, control, and oversight of the program by our state officials. You don’t have to like the law to be pragmatic enough to realize that a federally-established and -run exchange provides the least flexibility and the least ability to oversee and address the problems that are inevitably going to arise.
At a time when ideological rigor and inflexibility have led to an inability to do the right things at our federal level, I applaud Gov. Otter for his leadership, and I applaud those in the legislature who have made sure that Idaho preserved the best possible options for Idahoans, despite the fact that there really were few options.
Now, let’s start making lemonade out of those lemons!
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.