1. IDAHO'S IMPLEMENTATION OF A STATE-BASED HEALTH EXCHANGE IS A FORM OF VOLUNTARY COMPLIANCE THAT SUPPORTS PPACA, AND THAT HAS NEGATIVE LEGAL IMPLICATIONS FOR IDAHO. Voluntary compliance, and the acceptance of federal money that comes with it, will weaken Idaho's legal position in lawsuits likely to be filed in the future. PPACA is very complicated and controversial. Aspects of it are certain to be litigated for years to come. Examples of potential lawsuits include: mandatory coverage for the dispensing of abortifacients, and the federal government's use/misuse of personal data gathered on citizens.
The State of Oklahoma has already filed a lawsuit claiming that the federal government does not have the power to mandate individuals to buy health insurance simply as a condition of being a citizen. Idaho may want to take similar action(s), and that will be more difficult if Idaho is a voluntary compliant federal partner operating a state-based exchange.
2. IDAHO'S VOLUNTARY IMPLEMENTATION OF A STATE BASED EXCHANGE WILL ALSO MEAN THAT THE STATE WILL BE IN CHARGE OF ENFORCEMENT OF PPACA - There are at least six mandates in PPACA that have to do with the collection of personal information on citizens; including information regarding income, assets, and personal health. Implementation of PPACA will result in the creation of a massive, personal database on all Americans. One can only speculate on the governments' potential uses (or misuses) of this data. Many Idahoans will not want to provide this information; and the state would be in charge of enforcement. Enforcement actions will create friction between state government and the people it serves. Federal officials know that enforcement of PPACA will be very unpopular and they do not want this responsibility.
3. FOR THE LONG-TERM HEALTH OF THE PRIVATE INSURANCE INDUSTRY - Part of the evil genius of PPACA is that it depends on the private insurance industry to put the exchange mechanism in place. Ironically the organizations pushing hardest to implement state-based exchanges (the insurance carriers) have the most to lose, and here is why:
PPACA provides a government mandated increase in the number of policy-holders. Over the short-term, this will result in significant increases in revenue to insurance carriers; and understandably that is very exciting to the industry. However, what the insurance carriers aren't considering is the long-term impact of a nation-wide exchange system under the auspice of the federal government. Once exchanges are implemented nation-wide, dependence on insurance carriers will be significantly reduced. At that point the system will be in place and it will make fiscal sense for the federal government to transition to a single-payer, federally administered social health care system nationwide. Maybe a few large carriers will remain (to run the books), but the private insurance industry as we know it will be gone. No one knows for sure exactly what will happen or how soon, but at a minimum the health insurance industry will be an oligopoly of quasi government administrators. At maximum, they will be gone. Either way, it is a devastating loss of free market capitalism in America.
4. IT IS IRRESPONSIBLE FOR STATE LEADERS TO IMPOSE LEGISLATION UPON THE CITIZENS IT SERVES FOR WHICH NO ONE NOWS THE COSTS AND THE RULES. The costs are not known and the rules are not written yet. It is responsible and wise to have the answers to these questions answered before proceeding with a state-based exchange.
According to the Kaiser Foundation, 25 states (as of Jan. 4, 2013) have opted NOT to cooperate with the federal government via a state-based exchange. With expertise and fiscal resources scarce, and with other complications caused by an unpopular nationwide mandate for citizens to purchase insurance (PPACA), the federal government is under immense pressure having to impose federal-based exchanges in so many states. The feds should be granted every opportunity to fail, and hopefully they will. Additionally, there are other political dynamics are at work in Washington DC that can make life more difficult for those seeking to implement PPACA. For example: The "fiscal cliff" (& ramifications) and the debt ceiling (& ramifications)...basically all the wondrous side-effects of a government in debt some $16 trillion.
The Idaho Republican Party, Farm Bureau, Tea Party, Idaho Freedom Foundation, Idaho Chooses Life and many others are correct: Idaho has much to gain and little to lose by refusing a state-based exchange. Accordingly, Idaho should be added to the growing list of states that do not comply.
Proponents of a state-based exchange claim such implementation "will put Idaho at the negotiating table". This is false. Once Idaho complies with the state-based exchange, there is NO "negotiation table"...and there is no way the feds are going to make an exception for Idaho and sit down to negotiate terms.
Proponents also claim Idaho needs to "leave its options open". This is good policy and substantiates the decision NOT to cooperate with a state-based exchange unless we absolutely, positively have to someday. FYI: Both HHS (Human Health Services) and the Heritage Foundation agree that states can transition to a state based exchange later - even if the feds come in an impose one in the mean time. There is no rush.
If you believe in the principles of socialism and turning over an INCREMENTAL 1/6 of the nation-wide GDP to the federal government (via healthcare), then you will want to support the state-based exchange.
If you believe in the free market, capitalism, personal responsibility and liberty, you will NOT want to cooperate with a state-based exchange.