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Idaho's state-run health insurance exchange is expected to begin enrollment by Oct. 1, 2013 and fully functional by Jan. 1, 2014. The exchange is an online marketplace where Idahoans will be able to shop for and purchase health insurance. The Idaho Legislature approved plans to build the exchange in March 2013, but two years of intense debate preceded the vote.After the U.S. Supreme Court upheld the Obama Administration's federal health care overhaul in 2012, two key decisions rested with states. One, should states expand Medicaid to include more people? Two, should states create their own health insurance exchanges?Gov. C.L. "Butch" Otter chose not to make a snap judgement, instead, he created a work group to study whether Idaho should create it's own health insurance exchange, let the federal government create one for the state, or some combination of the two options.Otter's 14-member panel decided in October 2012 that Idaho should move forward with creating it's own exchange. The governor followed suit, and Gov. Otter issued a statement on Dec. 11, 2012 that Idaho should create a state-based exchange. Two Years Of DebateThe health insurance exchange debate has been ongoing ever since it became clear an exchange would be part of the federal health care reform package which was signed into law in 2010.Because Idaho didn't have the framework set up for a health insurance exchange, it was expected to be one of the biggest debates of the 2012 legislative sessionThe Associated Press held a special discussion of the issue during its January 2012 legislative preview. In a series of interviews that StateImpact conducted in December, legislator after legislator predicted it would be a defining issue of the months ahead.Instead, it was more or less dead on arrival. Not even a plan developed by Sen. Dean Cameron (R-Rupert) and Rep. Fred Wood (R-Burley) for a stripped-down, state-run exchange could muster sufficient support.Health insurance exchanges are a primary component of the Affordable Care Act. By their most basic description, exchanges are organizations — essentially online marketplaces — intended to make health insurance options more clear and, thereby, more competitive.The underlying logic is this: individuals and small businesses don’t have perfect information or a great deal of bargaining power with insurers. A health insurance exchange lays out the private and public health insurance options, explaining plans in terms of benefits and costs.Under the Affordable Care Act, states can create their own exchanges or wait for the federal government to do it for them.Rep. Wood says it was ideological opposition to the health care law that did in the prospects for a state-run exchange. “I think there was a certain number of people that simply didn’t want anything to do with an exchange,” he said. “And they were in a position that they could affect that outcome. In other words: no exchange.”Wood, a retired physician and former director of the Cassia Regional Medical Center, believes state lawmakers are rolling the dice, hoping the federal health care law will be overturned. “They’re betting that the Supreme Court will strike down the entire law,” he said. “And if we bet the wrong way, it could be very costly for the state.”Costly because states creating their own exchanges will have some discretion to set the essential benefits that must be provided by insurers. But states falling under the federal plan likely won’t have that same flexibility. The Idaho Department of Insurance has predicted Idaho employers could expect to pay millions more in health care costs under a federal exchange.

Seasonal Firefighters Receive Health Insurance, But Not All Are Satisfied

Jessica Murri
/
Boise State Public Radio

It’s the height of fire season in Idaho and hundreds of seasonal firefighters are busy.

For the first time, they’re eligible for federal health insurance. President Obama made the change in July.

Many of these firefighters have gone without insurance because of the cost. While the new benefits have been welcomed, one Boise-based firefighter finds that the new health insurance won’t help her.

Emma Kaage lifts a 95 pound barbell above her head, and lets it drop to the floor, before she picks it up again. The 25-year-old does CrossFit training twice a day.

Kaage is surrounded here by men - something she’s used to. For the past six years, she’s been a seasonal firefighter. But because of chronic pain, she took this summer off. She wishes she didn’t have to.

“I really miss not sleeping on the ground,” Kaage says. “I miss looking for shooting stars every night. I miss traveling with the crew. I like riding in helicopters. I like the hikes.”

One day last summer while hiking up a steep cliff, Kaage says she felt overwhelmed with pain. She separated from the group, laid down, and realized she hurt too much to continue.

“That point was the time when I said, ‘You have to remember this moment. You are lying on the top of a mountain crying next to a fire,’” Kaage says. “‘You can’t do this anymore.’”

Kaage broke her tailbone as a child and it didn’t heal right. Now she goes to three physical therapy appointments a week and CrossFit is also part of her training to get better. She’s not fighting fires this summer because she’s trying to use her parents’ health insurance as much as she can before January. That’s when she turns 26 and won’t be eligible anymore.

But if she continues fighting fires next summer, she’ll have an option she hasn’t had before. After an outcry by those who fight wildfires earlier this summer, President Obama ordered his administration to offer health insurance to seasonal firefighters.

John O’Brien oversees health care and insurance for federal employees. He says the government pays up to 75 percent of the medical insurance for its workers. That costs the government nearly $400 a month for a single person, or almost $900 for a family.

“I think it’s a really good thing,” O’Brien says. “They’re doing very, very hard work and we as their employer when they are employed should be providing an employer share to their health insurance.”

Kaage, though, has mixed feelings. She calls it a nice gesture, but questions it’s usefulness.

Seasonal firefighters are covered while fighting fires, but that’s also the worst possible time for them to schedule appointments or procedures. Firefighters often have to cancel appointments when called out on a fire.

Then there’s the cost. Seasonal firefighters pay $130 a month for the insurance during the season, but once that ends, the cost of the plan quadruples.

“We’re not claiming this solves everyone’s problems, but it is an improvement over what it was in the past,” O’Brien says.

O’Brien guesses around 6,000 seasonal firefighters will use the plan. He says though it’s an expensive premium, the cost is comparable to the private market.

For Kaage, it’s a catch-22. She can’t afford the government insurance during the off-season, but continuing her current routine of doctors appointments wouldn’t be possible if she was uninsured.

“That’s, I calculated it, that’s about $550-$600 per week and there is no way I can afford that. At all,” Kaage says.

In the meantime, Kaage continues her therapy and hopes to heal before she’s no longer eligible for her parents insurance. After that? She’s not sure. But she says a full-time job that would include year-round insurance is not an option.

“A lot of people were like, well, like, do you need to find an office job or a desk job and I was like, that is my worst nightmare. Like, no. Do not put me in a chair all day, it’s a horrible idea,” Kaage says.

Kaage says she’d like to fight fires again next summer. That, she’s sure of. But like so many others in the U.S., the future of her health insurance remains unclear.

Copyright 2012 Boise State Public Radio

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