“They lobbied greatly,” Idaho state Sen. Monty Pearce, a Republican exchange opponent, told me about the health care sector and the legislation to create the insurance exchange. “They’ve been lobbying on it for a couple of years. … They’ve hired every lobbyist they can get.”

The Idaho Hospital Association has made a state exchange a priority while also lobbying to expand Medicaid. Another leading exchange backer is the Idaho Association of Commerce & Industry — one of the biggest-spending lobbying organizations in Boise. Dozens of Idaho businesses, led by insurers and health-care providers, formed the Idaho Health Exchange Alliance to back Otter’s push for an exchange.

These pro-exchange health-industry companies also poured money into legislative campaigns. Comb through the campaign finance disclosures of most Idaho state senators and you’ll see gifts from drugmakers (GlaxoSmithKline and Pfizer), insurers (Blue Cross of Idaho and PacificSource Health Plans) and industry groups (Idaho Hospital Association, the Pharmaceutical Research and Manufacturers of America, and the Idaho Health Care Association). All these companies benefit from a state-run exchange.