Among the insights from Joy Wilson of the National Conference of State Legislatures into the health care choices facing states like Idaho: "The Medicaid expansion affects every state differently. ... Most states are in the process of running numbers to try to determine what the impact will be of the expansion in their state." That's key for all states to do, she told the Idaho Legislature's Health Care Task Force this morning.

On health insurance exchanges, there is a Nov. 16 deadline and three choices for states: A state-run exchange, a federally run exchange, or a partnership exchange, in which the federal government and state share duties, with states handling the eligibility, operations and/or the consumer assistance portions of the exchange.

She also noted that by Sept. 30, states must declare what their essential health benefit package is going to be. "The default plan would be the small group plan in your state with the largest enrollment," Wilson said. "For the most part, state insurance commissioners are making the decisions," though in some states, legislators are participating. Wilson also noted that deficit reduction actions in Congress could affect funding for aspects of Medicaid. "It is certain that there will be significant reductions in discretionary health programs as part of deficit reduction," Wilson said.