Idaho was the only state in the nation led entirely by Republicans that chose to run its own health insurance exchange. There were many twists along the way, including the rejection of federal grants, nullification bills, a veto, and an executive order. The issue split Republicans, with enough joining the Democrats to pass legislation. Prominent interest groups strongly supported state control, although they faced intense opposition from the Tea Party and conservative groups. Governor Butch Otter played a prominent role, working with key legislative leaders who happened to have particular expertise in health policy. However, the decision was made too late and the state did not have time to set up its exchange in time for the first enrollment period. It relied on the federal website the first year but had its own fully functional website one year later.
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