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Spokane, Washington  Est. May 19, 1883

Eye On Boise

IFF’s medical adviser says he opposes SHIP program, encourages people to volunteer at free clinics

Dr. John Livingston, a retired physician and surgeon who was appointed by Gov. Butch Otter to the Your Health Idaho insurance exchange board, is giving his part of the Idaho Freedom Foundation’s anti-Medicaid expansion pitch to the Legislature’s health coverage gap working group this morning. Livingston praised the exchange, saying it’s provided health insurance to 100,000 Idahoans and will soon be self-sustaining. “Our governor is to be congratulated for that effort,” he said.

Livingston said he’s changed his position on various health care issues in the past three years as a result of what he’s learned, coming to favor direct primary care as a result of working with Sen. Steven Thayn, R-Emmett; and supporting existing Community Health Clinics, as a result of working with Sen. Dan Schmidt, D-Moscow, Rep. John Rusche, D-Lewiston, and Stephen Weeg, the YHI board chairman, whom he thanked “for helping me come to that conclusion.”

But Livingston surprised lawmakers by saying he opposes the SHIP program, the Statewide Healthcare Innovation Plan, a major, grant-funded program spearheaded by the state Department of Health & Welfare that’s seeking to transform Idaho’s health care delivery and payment system. That approach is the same that’s being considered for a waiver program for an Idaho-designed gap coverage plan. The idea is to move away from the costly and inefficient fee-for-service model to a patient-centered medical home model, focused on value and better health outcomes for patients. Such a system would reward preventive care and management of chronic diseases, with the aim of driving down costs while keeping people healthier.

“I am absolutely 100 percent against the SHIP program,” Livingston told the panel. “The reason I’m against it is I see it as a command and control, top-down, vertically integrated system housed in the Department of Health & Welfare designed to control health care delivery for the state of Idaho.”

Livingston asked, “How can that possibly operate and cut costs more than the free-market system?”

Many lawmakers, including House Republicans who oppose outright Medicaid expansion, have just as fervently touted the SHIP program, and the need to transform Idaho’s health care system to make it more efficient and less costly.

Livingston said, “I believe that there are a proportion of patients in our state that need our help.” But he said it should just be the 15 to 20 percent of the gap population that “have chronic diseases that preclude them from being able to work,” saying, “That number is not 78,000 people.”

“If you truly want to participate in providing care to people on the margins, volunteer your services to free clinics – they’re all over the state,” Livingston said.

Livingston said, “We can utilize marketplace solutions.” Among those he said he’d favor: For physician assistants “to be given more ability to run their own clinics, and there may be a telemedicine component to this or something like that. But we need to get those people out in the field seeing patients.” He said the costs of Lasik and cosmetic surgeries, things patients generally must pay for in full themselves without the help of insurance, have dropped over the last 20 years. “That’s the marketplace,” he said.



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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