Idaho is one of the most conservative states in the country and — paradoxically — the only state led entirely by Republicans to choose to operate its own health insurance exchange as part of the Affordable Care Act (ACA). The decision was contentious, with tea party activists vowing to punish Republicans who voted for an exchange. Their No. 1 target was Gov. C.L. “Butch” Otter. They labeled the exchange “Ottercare” and said he took ownership of the law in Idaho once he announced support for a state-run exchange. Despite aggressive attacks, Otter and other supporters of Idaho’s exchange survived last week’s primaries relatively unscathed. The results indicate that the tea party and its attacks on “Obamacare” may not be as powerful as anticipated.
Idaho’s path is particularly ironic, given its role as one of the earliest and strongest critics of the ACA. Even before the ACA was signed into law in March 2010, the legislature passed the Idaho Health Freedom Act, preventing any state official from enforcing the individual mandate. Idaho was one of 13 states to file suit against the ACA within minutes of President Barack Obama’s bill-signing ceremony. The legislature even passed a nullification bill in 2011 declaring the ACA null and void in the state. Otter thought this went too far and vetoed the nullification bill, though he simultaneously issued an executive order that no part of the ACA could be implemented without his permission.
Otter was one of the many Republicans who faced a dilemma in late 2012 after the Supreme Court upheld most elements of the ACA and Obama was re-elected. Creating an exchange would mean opening himself to attacks from the right just as he was getting ready to announce plans to run for a third term. Opposing an exchange would mean giving up control to the federal government over a policy he likely would have supported under different circumstances: Years before the ACA was enacted, Otter and his insurance commissioner, Bill Deal, talked about creating an online marketplace for health insurance as a way to increase transparency and facilitate competition in the insurance market. Otter reportedly said that his decision to support an exchange was the second most difficult choice he has made in public office, behind only his vote in Congress against the Patriot Act in October 2001.
Even with Otter’s support, an Idaho-run exchange was far from guaranteed. Exchange legislation had been blocked by House Speaker Lawrence Denney, who opposed the ACA to the point of not even allowing a hearing on exchange legislation. He was ousted by his party in December 2012 after controversially using his leadership PAC to try to defeat incumbent Republicans. Tea party activists mobilized aggressively against an exchange, attending legislative hearings in large numbers and shaming legislators as they left committee meetings. The Senate and the House each debated for more than six hours. Some Republicans compared creating an exchange to socialism and Nazi Germany; state Sen. Sheryl Nuxoll likened it to putting Jews on trains to concentration camps.
Despite this heated rhetoric, legislation to create an exchange passed both chambers and was signed into law by Otter in March 2013. The Republican caucus was split almost exactly evenly, with 14 House Republicans making up the difference. They favored maintaining state control and promised support at a key moment when it seemed exchange legislation was dead.
According to a recent report published by the State University of New York at Albany’s Rockefeller Institute of Government, it took so long for Idaho to decide to create an exchange that there was no time to develop the necessary technology. One of the very first acts of the newly appointed exchange board in the spring of 2013 was to default to the federal website, HealthCare.gov. Wayne Hoffman of the Idaho Freedom Foundation, a conservative think tank, mocked the decision, saying, “The whole thing would be laughable if it wasn’t such a disgrace.” Supporters hoped they could have the best of both worlds: control over decisions they cared about without having the responsibility of creating the IT. When the first open enrollment period ended in April 2014, Idaho managed to have the fifth-highest enrollment in the nation in terms of percentage of the potential marketplace population enrolled.
Idaho’s 2014 Republican primary was billed as a test of the vitality and longevity of the tea party movement. Could they deliver on threats to defeat the Republicans who voted to create an exchange? A close look at the results suggests that the tea party in Idaho had relatively little electoral influence.
The race for the 2nd Congressional District received the most national attention, with incumbent Mike Simpson — an ally of U.S. House Speaker John Boehner ally — fighting off a challenge from tea party candidate Bryan Smith. Simpson won comfortably, receiving 62 percent of the vote. The Club for Growth saw the writing on the wall and pulled out of the race weeks ago. This result by itself does not indicate a weakened grass-roots tea party but does signify the challenge that national groups have in connecting at the local level.
The gubernatorial race also attracted national attention, though largely for the candidates known as the biker and the curmudgeon, colorful also-rans who were allowed to join the debate (which is worth watching, as is Stephen Colbert’s hilarious summary). Otter’s main challenger was Idaho’s Senate Republican caucus leader, Russ Fulcher, who had tea party support and promised to close the state exchange. Otter defended his support of an exchange as “keeping ‘Obamacare’ out of Idaho.” Otter won re-election by an 8-point margin, but his victory was hardly resounding, with a combined 49 percent voting for someone else.
The tea party’s weakness was most apparent in its inability to defeat state legislators, since the movement’s strength is supposed to be its ability to influence politics at the local level. Conservative groups targeted the new House speaker, along with the House Health and Welfare Committee chair and a co-chair of the powerful Joint Financing and Appropriations Committee, each of whom played a major role in creating an exchange. Conveniently for opponents, they came from the same district, so billboards could be used to target all three at once. Despite increased scrutiny and opposition, all three ran unopposed, indicating that no one in the district thought they could generate enough enthusiasm to defeat any of the incumbents.
The 14 freshmen Republicans who provided the key votes in the House faced an intense backlash from tea party activists in the months after passing the exchange bill, including votes of no confidence from county organizations and precinct-level revolts. Yet all but two were re-elected, including eight who were unopposed in their primaries. Rep. Luke Malek, widely seen as the leader of the freshmen group, won re-election by more than 5 percentage points. Of course, with low turnout in a small rural district, this amounted to only 200 votes between him and his challenger.
The results in northern Idaho reinforce the notion that the tea party is not dead. Four ultraconservative candidates survived despite Otter’s and other establishment Republicans’ support for their opponents. Three moderate incumbents were defeated by candidates with tea party support.
General elections tend not to matter much in Idaho politics, with the more important contests being decided in the primaries. Last week’s elections mean that Idaho’s government in January 2015 will be mostly unchanged from this year. This result suggests that conservatives in places such as Florida, Kansas and Wisconsin might have overreacted in their opposition to creating exchanges, particularly when they backpedaled and returned federal grant money for creating exchanges out of fear of upsetting the tea party. These results are consistent with a recent study by political scientists at the University of California at Berkeley and the University of Michigan that found that legislators have a tendency to overestimate conservatism in their districts. Another study highlighted that only 30 incumbents out of more than 5,000 state legislators nationally were defeated by tea party candidates in 2010 — arguably the height of the tea party’s power. If Republicans supporting an insurance exchange can survive tea party opposition in 2014 in ultraconservative Idaho, they likely could have survived elsewhere.