Armstrong on why PCAP’s not an entitlement: ‘We can drive the program as we see fit’
Dick Armstrong, director of the Idaho Department of Health & Welfare, told the Senate Health & Welfare Committee this afternoon that the governor’s proposed Primary Care Access Program is not an entitlement program. “I don’t see PCAP at all as an entitlement,” he said. “I know that there are those that run around wanting to call it that. But we will operate to the funding that we have available. And if we don’t have the funding, then we will use a wait list, plain and simple. If all 78,000 show up tomorrow and we don’t have the money, then all 78,000 will not get into service, we’ll have to ration it – that’s just the way it will be. All participants have to share in the cost, and they have to invest in their care plan, or they can be disenrolled.”
Auburn University’s glossary of political economy terms, written by political science professor Paul M. Johnson, has this definition of “entitlement program:” “The kind of government program that provides individuals with personal financial benefits (or sometimes special government-provided goods or services) to which an indefinite (but usually rather large) number of potential beneficiaries have a legal right (enforceable in court, if necessary) whenever they meet eligibility conditions that are specified by the standing law that authorizes the program.” He adds, “The most important examples of entitlement programs at the federal level in the United States would include Social Security, Medicare, and Medicaid, most Veterans' Administration programs, federal employee and military retirement plans, unemployment compensation, food stamps, and agricultural price support programs.
Armstrong, who briefed the Senate committee this afternoon about PCAP, said, “Entitlement programs, you can never un-enroll. But this is all our money, this is state of Idaho, and we can drive the program as we see fit.”
Armstrong ran through the details of how the PCAP program would work, from submitting an application through the state’s existing application process that’s also used for Medicaid, the state insurance exchange, and welfare; to, if found eligible, being assigned to an area clinic; to being contacted by the clinic about doing a detailed health assessment and developing a plan for addressing the patient’s health care needs; to getting services ranging from preventive care to in-clinic behavioral health treatment.
Though PCAP wouldn’t be insurance – patients would pay fees for services on a sliding scale, based on their income – it would include deep discounts on an array of medications, Armstrong said. “Currently the Community Health Centers have access to some extremely valuable discounts, deep discounts,” he said. “Most of these are the basic medications for everyday life; their formulary actually has about 2,800 medications. Those are all the ones that are typically available for primary care.”
He offered some examples: A diabetes medication with an average wholesale price of $484 would cost a patient $17.16; an asthma inhaler priced at $85.39 would cost the patient $17.08. And patients would be directed to any cheaper alternatives that are available, including $4 prescriptions at WalMart.
Patients will have to be responsible for complying with their care plans; if they don’t, they could be kicked out of the program. “It’s a change of philosophy,” Armstrong said. “It’s a very different delivery model than what we’ve all kind of been used to for the last 50 years. The last 50 years has been you’ve got to go find the provider if you want a service.” Under the “patient-centered medical home” model that would be used in PCAP, a team of providers would help alert the patient to what they need to do to stay healthy – and where to go when they need care. “There is an education process that has to take place here, plain and simple,” Armstrong said, “and we will have to work on that, because this is a change of culture – and that’s what we’re after.”
Armstrong, who serves on the Catastrophic Health Care program board, offered examples of the kinds of catastrophic cases that end up at the CAT fund. In one case, a 61-year-old male with edema and diabetes ran up a hospital bill of $191,000. In another, a 42-year-old female hospitalized for a foot abscess caused by undiagnosed diabetes incurred a $70,355 bill. “This is typical – we see these come through all the time,” he said. “Basically these are individuals who, if they had some kind of ongoing medical assistance and somebody looking at them a little more deeply, they might have been able to control this disease state and we wouldn’t have had these huge bills.”
He said, “We want to use the current infrastructure and the current medical system, engage the gap population. … It engages the gap population in regular medical care that Idaho can use to build on for the future, if we choose to continue the program.”
Armstrong, who will brief the House Health & Welfare Committee on Wednesday, drew praise from the senators. “I applaud you for thinking outside the box and focusing on health care instead of insurance,” said Sen. Marv Hagedorn, R-Meridian. Sen. Mark Harris, R-Soda Springs, said, “I’m happy about this plan, I really am – I’m excited about it.” Sen. Patti Anne Lodge, R-Huston, said Armstrong’s presentation “really clarified a lot of the questions that I had. I think that the key to this is getting people to go to the clinics – somebody calls them that really cares about them.”
Armstrong said it’s “heartbreaking” to see the state spend hundreds of thousands of dollars on the catastrophic bills of a patient with Stage 4 breast cancer, when no good outcome is even possible. “We spend all this money at the wrong end of the spectrum, and we’ve seen those claims over and over again,” he said. “But if we got ahead of it just a little bit, there’s a chance. … I’ll take a little bit any time. We realize it’s not the whole answer, but we’re at least going to make a huge effort to get people at least a little bit ahead of that disease state, any way we can do it.”
