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Eye On Boise

Mon., March 25, 2013, 7:18 a.m.

On putting off decision on Medicaid expansion…

At the close of Friday morning’s joint meeting of the House and Senate Health & Welfare committees, Sen. Dan Schmidt, D-Moscow, moved to send HB 309 to the floor of the House with a recommendation from both panels that it pass. But his motion was ruled out of order; Chairman Fred Wood said the meeting had only been noticed as a informational one, and the committee couldn’t pass the bill without taking public testimony.

The committee had just heard some rather stunning figures, including that expanding Medicaid this year could bring the Idaho economy a $9.2 billion boost over the next 10 years. The expansion, which would be 100 percent federally funded for the first three years and then phase down to 90 percent, would replace the current state-county medical indigency and catastrophic care program, which is funded 100 percent from the state general fund and local property taxes. The latest estimates show both the state and local property taxpayers could save tens of millions with the optional expansion, which would provide health coverage, including mental health, to the population that’s now eligible for the costly catastrophic care reimbursement program.

After the meeting, Schmidt said, “There has been a lot of effort put forward. … I think it’s doable, and I think it’s doable this year. It’s just going to take some effort – and probably courage.”

Later on Friday, House Speaker Scott Bedke offered an answer of his own: “I think it’s an important issue that the state needs to take a look at,” he said. “I think having those bills in the public domain over the interim can accomplish that. I am not going to get out ahead of the governor’s office on that issue. At first blush it appears there could be significant property tax relief to the whole state – not just personal property tax, but property tax for everybody. We ought to look at that.”

However, Bedke said, “We are going to be done by Friday, and I don’t think we can give that issue the thorough public vetting that it needs between now and then."

“They have my full attention, because it seems to offer very, very significant property tax relief.” You can read my full Sunday column here; click below for a full report from AP reporter John Miller.

Lawmakers won't tackle Medicaid in 2013 session
By JOHN MILLER, Associated Press

BOISE, Idaho (AP) — Expanding Medicaid to cover more low-income Idaho residents could save state and local taxpayers tens of millions over the next decade, according to a state-financed report released this week, but lawmakers won't tackle the issue during the 2013 session due to end next week.

House Speaker Scott Bedke said there isn't enough time left, even though he thinks the potential merits of expansion shouldn't be overlooked. It could mean some $478 million in county property tax reductions for Idaho residents through 2024, according to the report from the Idaho Department of Health and Welfare.

"We are going to be done by Friday," said Bedke, R-Burley. "I don't think we can give that issue the proper vetting it deserves."

Part of the holdup is, Republicans exhausted considerable political capital on another key provision of President Obama's overhaul when they passed a state-based health insurance exchange, after a combined 16 hours of debate in the House and Senate in which backers of the bill were accused by some foes of acquiescing to federal intrusion into Idaho.

Consequently, GOP appetite to tackle Medicaid expansion, a provision of the 2010 federal law that the U.S. Supreme Court left to states to decide, is limited especially given the bruising debate sure to accompany it.

"Politics are what's going to block it," said House Minority Leader John Rusche, D-Lewiston and former insurance executive, favors expansion.

Among other things, Rusche said, expanding Medicaid would move more than 100,000 low-income Idaho residents into a system of medical care that includes mental health services, a departure from the existing program that pays the medical bills of poor patients only after treatment.

That program, Idaho's catastrophic health insurance fund, is running about $65 million annually for the state and counties combined, but would be eliminated under Medicaid expansion.

Another obstacle to adopting expansion this year is Gov. C.L. "Butch" Otter: Jon Hanian, his spokesman, said Friday nothing has changed to move the Republican governor from the position he took in his Jan. 7 State of the State speech: Idaho should hold off on expanding Medicaid, at least until a broken system has been fixed.

At Otter's direction, the Idaho Department of Health and Welfare has been working since then to secure an agreement from the federal government to allow the state to modify how its Medicaid program would cover an expanded population.

Among other things, Health and Welfare Director Dick Armstrong is seeking changes that promote patient responsibility and encourages providers to focus on outcomes, rather than simply providing services for which they can bill the government.

On Friday, Armstrong said he's optimistic about winning an agreement from the U.S. Department of Health and Human Services and believes he could have a new program in place during 2014. He added that officials in Washington, D.C. have at least verbally offered encouragement; now, he said, he wants it in writing.

"We're now testing their mettle," Armstrong said. "We're saying, 'You opened the door, we're walking through.' "

Last year, Otter commissioned a 15-member committee to scrutinize how expanding Medicaid to more people. This week, the panel met again to review Health and Welfare's savings projections — and was in the process Friday of sending Otter a letter urging him to back Medicaid expansion, members said.

Idaho Hospital Association president Steve Millard, who is on Otter's panel, conceded it would take nothing short of the full force of the governor's leadership, if something were happen this session.

"I don't know if he appreciates the urgency," Millard said. "Our letter shows that in spades, the urgency."

Copyright 2013 The Associated Press.

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Betsy Z. Russell
Betsy Z. Russell joined The Spokesman-Review in 1991. She currently is a reporter in the Boise Bureau covering Idaho state government and politics, and other news from Idaho's state capital.

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