Alex LaBeau, head of the Idaho Association of Commerce and Industry, said it's difficult for private businesses involved in different aspects of health care to agree on many issues, but they agree that "yes, the state should have a state-run exchange." He said, "We have to deal with the reality that has been put in front of us, which is a federal law that impacts the residents in this state. ... We support having a state-based exchange."

LaBeau compared the issue to environmental regulation. "I can tell you that it is a lot easier to deal with the state's DEQ than it is the EPA. The same principle applies here," he said. "I'd rather deal with Director Deal than deal with HHS." He said accepting "ready-made money available" from the federal government to set up the exchange only makes sense. "We as employers do not like uncertainty," LaBeau said. "Having a state-run exchange gives us a lot more confidence." Idaho employers could have some say in a state-run exchange, but not in a federal one, he said. Not moving forward with a state exchange, he said, could hurt job creation in the state. Regardless of ideology, he said, "There are very fundamental pragmatic issues that business needs to deal with this year."