COEUR d'ALENE - Mark Fisher contends that there isn't much difference between either a federal or state-based health-insurance exchange.
Fisher - owner of Advanced Benefits in Coeur d'Alene, an employee benefits insurance and consulting firm - opposes both for Idaho.
"Let's dispel the myth that (exchanges) are a shopper's paradise where you can simply log into an Expedia.com-type site and in the comfort of your home pick a plan that is right for your needs from a multitude of plans that might be available," Fisher said.
Fisher, who ran for the Idaho Legislature last year, spoke Thursday at a meeting of the Kootenai County Reagan Republicans at The Fedora Pub and Grille, in Coeur d'Alene.
"Insurance companies, hospitals and other providers are most interested in a state-based exchange," Fisher said.
Companies like Blue Cross of Idaho have the most to lose if Idaho chooses to participate in a federal exchange, he said.
In a federal exchange, companies like Aetna and United Healthcare could be selected through a competitive-bid process.
"Those are two carriers that don't really operate too much in Idaho now," Fisher said.
He said a state like Vermont has decided it will have only one carrier in its exchange - what would be considered a "closed exchange" - and it will be shopped out every three or four years.
"So all the insurance companies are out of business up in Vermont," Fisher said.
He said it's a lie to argue that health-care insurance exchanges will provide consumers with choice and affordability.
"By law carriers must offer the same rates in and out of the exchange for the same plan," Fisher said. "So there won't be any greater affordability."
Also, he said, the promised subsidies in exchanges won't make insurance more affordable.
He wants to clear up some misconceptions, he said.
First, he said, it is true that Idaho has the second-lowest health insurance rates in the country.
That said, it's not true that Idaho would lose those super-low rates if it doesn't create a state-based health-care insurance exchange. Some have said that without a state exchange, Idaho would be pooled with larger states and lose its lower rates.
"Even the governor is getting kind of duped into this," he said.
He said the exchanges are allowed to be geographically rated.
He hopes that states like Idaho resist implementation of federal health-care reforms that are tied to President Barack Obama's Patient Protection and Affordable Care Act, popularly known as "Obamacare."
Fisher criticized Obamacare for not doing enough to reduce the cost of medical care and prescription drugs. The average bill for a patient coming out of a hospital is $18,000, he said.
Idaho should hold off on creating a state exchange, "So that we have some time to get the bugs worked out before we spend any more time or more money moving forward with this," Fisher said.
He said Idaho has the option of converting to a state-based exchange at any future year.
"Every November we can re-evaluate," he said.
In a future year, Idaho can copy another state if it has developed a successful state exchange.
Until then, it doesn't hurt to wait, he said.
He also shared his concerns about the depth and type of information consumers will have to provide to participate in a future exchange.
He's concerned about costs of an exchange, too.
Fisher said it would cost $70 million to develop a state exchange in Idaho. He said he has also seen numbers estimating it will cost approximately $150 to $200 per person annually to run a state exchange.
He argued there are too many unknowns at this time, and a state-based exchange now would be hastily created. He said it would be better to wait and learn from others.
"A state-based exchange at this time, in my mind, is unnecessary," Fisher said. "It falsely indicates support for a law that most Idaho citizens reject."