Members of the governor's Medicaid expansion working group are now each sharing "guiding principles" they want to see help guide the panel's future decision on how to proceed. Rep. Fred Wood, R-Burley, a physician, said the group needs clear, easily understood graphics comparing the costs of each option. "If we really believe that it's going to cost us less in the future, we have to be able to show that," he said. He said there's concern about "creating an adverse business environment in the state of Idaho because we won't expand Medicaid," to the point that a business considering relocating to the state might say, "Wait a minute, you want me to come to the state of Idaho and pick up a part of your indigent care? We're not coming."

Susie Pouliot of the Idaho Medical Association said the IMA physicians took a policy position in July in favor of expanding Medicaid in Idaho. She said their hope was not only to get patients into "the appropriate care ... at a more appropriate cost," but also to make the move part of a transformation of health care in Idaho, into a more managed-care type environment, with a medical home model, with community care networks, so that "coordination and transitions are managed in a way that produces good health results."

Sen. Patti Anne Lodge, R-Huston, said this summer she's received more letters, emails and personal contacts than ever before in a campaign season, and they're on this issue. Lodge said many of her constituents are telling her "they don't like Obamacare and they don't want anything that has anything to do with it," and it's challenging to explain to them the issues involved. "We are not doing a good enough job ... to show the taxpayers and the citizenry what the costs are going to be," she said.

Gooding County Commissioner Tom Faulkner said, "I think we do want to make the point that we want to promote a strong business environment by minimizing the taxes and the costs to the citizens of the state. That is a big deal." He added, "Part of the problem with our health care is our providers are going through the roof with the costs ... just because they could get away with charging us whatever they want to charge us."

Dan Chadwick, head of the Idaho Association of Counties, said of the existing medical indigency program, "They're unsustainable numbers. We cannot afford those any longer. And those same people that are going to the county now for assistance are the ones that are paying those increased property taxes or state taxes." He said the current system "puts incredible pressure on county governments trying to keep up with those costs, simply because they're not predictable."