TWIN FALLS • With an insurance exchange deadline looming this November, Idaho’s leaders must figure out what steps the state should take next. But first, they must navigate confusing information and a politically charged climate to get there.

Earlier this month, Gov. C.L. “Butch” Otter appointed two working groups to analyze and make recommendations on whether the state should expand Medicaid and establish a state-run insurance exchange, two optional provisions of the Affordable Care Act. If the state decides not to implement an exchange, the federal government will set one up.

Meanwhile, a legislative Health Care Task Force, co-chaired by Sen. Dean Cameron, R-Rupert, and Rep. Gary Collins, R-Nampa, is meeting Monday to discuss potential actions the Legislature can take in response to the June Supreme Court Ruling that upheld the Affordable Care Act.

Rep. Fred Wood, R-Burley, will serve on both the task force and the working group considering Medicaid expansion. The key issue, he said, is exploring the big-picture fiscal impact of any given action.

That financial analysis is already murky.

In an opinion released earlier this month, Otter said he wouldn’t automatically reject Medicaid expansion and a state-run health care exchange, like Republican governors Bobby Jindal, Rick Perry and Scott Walker. Otter’s decision came despite pressure to shun Obamacare from Idaho’s Republican leaders, including House Speaker Lawerence Denney, House Majority Leader Mike Moyle and U.S. Rep. Raul Labrador.

But, Otter said, he is concerned about how Medicaid expansion will affect Idaho.

“Our estimates now are pretty amorphous, but some approximations put the added cost at $245 million by 2020,” Otter wrote. “That’s about as much as we are appropriating from general tax receipts in the coming budget year for all our colleges, universities and community colleges combined.”

The $245 million figure comes from a 2010 Idaho Department of Health and Welfare estimate, said Otter spokesman Jon Hanian. Hanian emphasized there are still

plenty of unknowns.

Otter compared the expense to an annual expenditure the state makes for higher education, but that $245 million represents an expense spread over seven years, said Tom Shanahan, public information officer for the Department of Health and Welfare.

Regardless of whether Idaho expands Medicaid, Shanahan said, the state will still pay more for Medicaid coverage.

Currently, the department estimates there are 20,000 Idahoans, mostly children, who are eligible for Medicaid, but not currently enrolled. When the individual mandate kicks in, many will come onto the system, Shanahan said.

Shanahan also pointed out that many uninsured people are likely receiving health care through county indigent funds or catastrophic health care funds.

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To further analyze the cost to taxpayers, the Department of Health and Welfare contracted with Utah-based firm Leavitt Partners to study the impacts of Medicaid expansion in Idaho. Those results are due in September, Shanahan said.

But the two working groups and Health Care Task Force are meeting before that September due date, possibly making recommendations on numbers that are still fluid.

On Tuesday, Wood said he hoped group members would set aside politics and look for solutions.

Sen. Dan Schmidt, D-Moscow, will also serve on both the task force and the Medicaid working group. He expressed optimism that group members could frankly discuss the issues.

“We all need to try to work to have open minds and listen to our constituents and listen to other people, too,” he said. “That to me is what the working group is.”

Wood agreed.

“Let’s sit back, let’s look at the analysis,” Wood said. “Look and determine how this is going to help or hinder the citizens of the state of Idaho, and then make a decision based upon that analysis as opposed to making a decision based on any other reason.”

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