Angered by a federal health care law that most of them despise, North Dakota House Republicans defeated legislation Thursday to give state officials authority over a health insurance marketing agency that the law requires states to establish.
They said endorsing state administration of the agency, which is called a health insurance exchange, would be tantamount to approving the federal health reform law itself.
"I certainly am not going to legitimize Obamacare with my vote," said Rep. Wes Belter, R-Fargo. "We, as a state of North Dakota, need to follow some of the other states who have said no ... It is the law, but the fight should not be over."
Supporters of the state law warned that if the state does not assume responsibility for running the exchange, the federal government would do so. They said Thursday's vote was the state's last realistic chance for running its own exchange, since deadlines are looming and the Legislature does not meet again until January 2013.
State administration would provide less expensive and more responsive service for North Dakota health insurance customers, said Rep. Jim Kasper, R-Fargo.
Kasper has been one of the Legislature's most vocal critics of the federal health care law. He argued that it made no sense to use that opposition as a pretext for rejecting state administration of the exchange.
"If you have a complaint ... where are you going to go? Call up Washington, D.C., and ask for someone? That doesn't work very good," Kasper said.
After a debate that lasted almost two hours, representatives voted 64-30 late Thursday to reject the legislation. All but 10 of the House's 69 Republicans voted against the bill, while 20 of its 25 Democrats supported it.
The vote came as lawmakers prepared to end their weeklong special session on today.
Rep. Lee Kaldor, D-Mayville, said the legislation was "about asserting our rights and our privileges as North Dakotans."
"Whatever our feelings are about the politics of the health care affordability act, whether it was right or wrong, it passed ... It's the law of the land," Kaldor said. "Let's not let the politics of what's gone on in the last couple of years put us in a position where we confront ourselves with an untenable option."
The exchanges are intended to offer subsidized health insurance to people who don't have coverage, and small businesses that cannot afford to extend health benefits to their employees.
Rep. George Keiser, R-Bismarck, said exchanges would offer Internet portals to help consumers evaluate a menu of insurance plans and discover whether they were eligible for public assistance in paying for coverage.
Providing a state-run exchange would allow for more variety in health insurance offerings, Keiser said. If North Dakota opts for federal administration of its health exchange, it is likely to be lumped into a multistate plan with less consumer choice, Keiser said.
"We're going to have a basic, core exchange, and that's it, and it's not going to be flexible," Keiser said.
Critics of the measure said other rural states have declined to undertake their own administration of health insurance exchanges because of worries about the expense and sheer complexity of the task. The projected $10 million cost of operating a North Dakota exchange every two years "is simply a guess," said Rep. Mark Dosch, R-Bismarck.
"We are being thrown into a race by the federal government and say, ‘Start running,' but unfortunately, they haven't quite figured out where the finish line is supposed to be," Dosch said.
Some Republicans, including Rep. Al Carlson, R-Fargo, the House majority leader, said they believed the state could still opt for state administration of its exchange even if lawmakers declined to do so now.
Kasper and Keiser disagreed, saying deadlines would pass before the Legislature's next regular session, and that there would be restrictions on state administration if North Dakota lawmakers made a tardy decision that they wanted the option after all.
"If we don't do it now, we won't be able to do it later," Kasper said.
Opponents of the bill said they resented the pressure, which they said was caused by unrealistic deadlines in the federal health care law.
Rep. Keith Kempenich, R-Bowman, compared the situation to high-pressure sales tactics in a used car lot.
"If the federal government was really sincere on trying to reform health care, they wouldn't have put these artificial dates in," Kempenich said. "Whenever I've seen things that get rushed like this, or they get where you're pressured like this, usually, they're full of it, and that's what this is starting to look like."