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Posts tagged: health care reform

Consultant: Long-term analysis shows big savings if Idaho expands Medicaid

Gov. Butch Otter's Medicaid expansion working group is receiving a report from consulting group  Milliman this morning on the potential impacts to the state. “On a purely financial basis, it would make sense to expand,” Justin Birrell of Milliman told the working group. “You save $6.5 million if you expand. It would cost you $284 million if you don't.” That's over a 10-1/2 year period starting in the second half of state fiscal year 2014. Added the firm's Ben Diederich, “The state and local offsets are what's very unique to Idaho.”

That's because of how Idaho currently funds health care for the indigent; through the state's medical indigency/Catastrophic Health Care program, the money comes entirely from the state general fund and from local property tax money. This afternoon, the working group is scheduled to decide on its recommendation to Otter on what the state should do; under the national health care reform law, states have the option of expanding their Medicaid programs largely at federal expense.

Working group votes for non-profit state-run health insurance exchange

Gov. Butch Otter's health insurance exchange working group has voted overwhelmingly in favor of a state-based health insurance exchange, opting for the model of using a private non-profit group set up by the state to run it. The recommendation now goes to Otter, who must notify the federal government of which way the state will go by Nov. 16. If the state does nothing, it gets a federally run health insurance exchange and loses state regulatory control over its health insurance industry. Rep. Lynn Luker's substitute motion to hold off on any decision for a year was overwhelmingly rejected. Only two members, Luker and Wayne Hoffman, dissented in the panel's decision.

Luker: Let’s wait a year on insurance exchange

Rep. Lynn Luker, R-Boise, has offered a substitute motion at the Health Insurance Exchange Working Group to defer a decision for one year; Wayne Hoffman seconded his motion. Luker said he wants to “defer this decision 'til after the election, 'til after we see what the federal government does with implementing a federal exchange, which we're probably going to get anyway given our level of preparation, and that we reconsider this in a year.” If the substitute motion fails, Alex LaBeau's original motion is still on the table.

Rep. John Rusche, D-Lewiston, said opting for a federal exchange would mean much higher health insurance costs for Idahoans, “charging the citizens of the state of Idaho $120 million more for basically the same insurance they're getting now.”

Panel member Tom Shores said, “I think the problem is we've waited long enough. We couldn't get the Legislature to do anything.” Waiting again, he said, would be “folly.” John Watts said, “I just don't know why we'd want the federal government to control absolutely everything if we have an option to avoid that.”

Exchange working group debates, Hoffman compares feds to abusive spouse

As the Health Insurance Exchange Working Group ponders Alex LaBeau's motion to support a state-based health insurance exchange, Wayne Hoffman, a group member, spoke out in opposition, comparing the state's relationship with the federal government to “the relationship of an abuser to a spouse. We keep getting beat up by the federal government and we keep running back to the federal government, and we have done it time and time again.” He said, “I think the best interest of the state is  to continue to resist this constitutionally dubious federal law. … The only way you're going to get the federal government, Congress and the executive branch to reconsider the law is just to resist its implementation.”

LaBeau said, “We're all paying for everybody's health care as it is, whether it's thru Medicare and Medicaid, your property taxes or your insurance. The other important thing to remember, in a small state like Idaho, this is going to impact small employers.” He said small employers - those with 50 or fewer employees - are 96 percent of Idaho's employers, and they employ half of Idaho's workers. “That's a substantial number of Idahoans that are going to be impacted by the decision that is made here today.” LaBeau called for a state-based exchange, using a private non-profit model, “because it's the most flexible.” He said a state-based exchange is the only way Idaho can protect small employers from big jumps in their costs and maintain Idaho's regulatory role over its insurance industry.

Panel member Kevin Settles said, “We need to get past arguing the legality of the law. The Supreme Court settled the issue.” He said, “We can make something good out of this. … With the state-based non-profit exchange, we can make it reflect Idaho.” He noted that Idaho's current insurance premiums are among the lowest in the nation.

Pressure on as insurance exchange working group holds final meeting today…

As Gov. Butch Otter's health insurance exchange working group holds its final meeting today, to settle on its recommendation to the governor, a group calling itself the Idaho Health Exchange Alliance has swelled to 316 members around the state, pressing for a state-based insurance exchange, rather than allowing the federal government to run an exchange for the state. The members include insurers and insurance agencies large and small, construction and manufacturing firms ranging from Oppenheimer Companies and Contractors Northwest to General Pneumatic Tools LLC and Madison Roofing, the Boise Metro Chamber of Commerce, the Idaho Academy of Family Physicians, Idaho Forest Group, the Twin Falls Canal Co., two auto-body repair businesses, the Idaho Association of Commerce and Industry, the Idaho Hospital Association and the Idaho Mining Association.

The alliance has sent a letter to the working group saying, “Our members encourage you to support the creation of a state-based health insurance exchange. Such a strategy is far superior to ceding design and control of something as important as health insurance to the federal government;” you can see the full letter here.

Meanwhile, the Idaho Main Street Alliance and the Idaho Community Action Network have scheduled a news conference this morning at 9:30 in room WW53 of the state Capitol, prior to the working group meeting, calling for an exchange plan that “works in the best interst of Idaho's small businesses and families, not cater(s) to insurance CEOs.” That group wants to make sure big insurers don't dominate the new exchange's board. “We need an exchange that will negotiate on our behalf, using our bargaining power to get the best plans at the best prices,” said Main Street Alliance leader Christina McNeil. “Small businesses deserve nothing less, and we should demand nothing less.”

The working group meeting is from 10 a.m. to 3:30 p.m. today in the Capitol Auditorium; you can see the agenda here, and watch live online here.


Wrestling with options for Idaho under health care reform…

The Idaho Legislature's Health Care Task Force, a joint committee of 14 senators and representatives, is hearing updates this morning on the progress of two working groups looking into how Idaho should proceed under the national health care reform law on two fronts: A health insurance exchange, and expansion of Medicaid. State Insurance Director Bill Deal told the lawmakers that the exchange working group will hold its final meeting this Friday, and will settle on its report and recommendations to Gov. Butch Otter on how to proceed.

State Health & Welfare Director Dick Armstrong told the task force that the Medicaid expansion working group is working through three options: Don't expand Medicaid and keep Idaho's current medical indigency/catastrophic health care fund as-is; don't expand Medicaid and revise the CAT fund system; or expand Medicaid. The no-change option would lead to very fast-growing costs both for the state and for county property taxpayers, Armstrong said. Forecasts show county costs would rise from $29.6 million a year today to $39.6 million a year in 2020, and state costs to the state's general fund from $39 million this year to $52.5 million in 2020.

Revising the CAT program likely would save only about 2 percent on costs, he said, with a new, standardized claims-processing system costing between $1.5 million and $3.5 million. Medicaid expansion, combined with other expected increases in Medicaid, would push Idaho's Medicaid program from the current 229,000 participants to an estimated 453,000 in 2020. Costs would be almost entirely borne by the federal government, though Armstrong warned that that could change in the future if federal policies change.

Sen. Dan Schmidt, D-Moscow, said the three options don't include one he's been hearing questions about when he goes door-to-door campaigning for re-election: Don't expand Medicaid and eliminate the CAT program, and just say Idaho won't pay for indigent people's medical costs. “Could the state of Idaho just say we're not going to pay for indigent health care?” Schmidt asked. “People argue that that's something we should consider.”

Armstrong responded, “Well, then the bad debt would fall on the hospitals and the providers. My first-blush guess is all of us that pay for our own hospital care through insurance, that difference would be immediately transferred. It would be an immediate cost shift to anybody and everybody that's paying for health care - they would have no choice.” He added, “It would mean all of the dollars would then end up moving to another pocket.”

Idaho insurers line up behind private non-profit option for exchange

Here's a news item from the Associated Press: BOISE, Idaho (AP) ― With a looming deadline approaching, insurers are making a last-ditch plea to Gov. C.L. “Butch” Otter for a nonprofit, state-based insurance exchange in Idaho as part of President Barack Obama's health care overhaul. On Tuesday, Idaho's advisers said the state likely has too little time ― and too much work still to complete ― to establish a state-run exchange by 2014. But insurance companies including Blue Cross of Idaho, Regence Blue Shield and PacificSource urge the state not to default to a federal exchange, like many states are doing. Jack Rovner, an attorney working for the insurers, says Idaho can still develop a state-based nonprofit to manage this online insurance marketplace. Insurers fear a federal exchange would invite regulation from Washington, D.C. Idaho must announce its intentions by Nov. 16.

Weighing costs, options, timing on health insurance exchange…

Consulting firm KPMG has offered some estimates of the costs for a state-based health insurance exchange: $77 million to set it up, and $10 million a year for operations. A partnership or “hybrid” exchange, in which the federal government would handle some aspects and the state others, would have a lower startup cost of about $15.5 million, and operating costs of about $1.7 million a year. Costs for the federally run option, as far as Idaho, couldn't be estimated. “There are grant funds available under all these scenarios,” said Sandy McBride of KPMG. Nevada, for example, received a $75 million federal grant for start-up of its exchange; Washington has received $152 million.

Gov. Butch Otter's health insurance exchange working group is meeting today in the Capitol Auditorium and will meet again in its final meeting on Oct. 24; you can see the agenda here and listen live here (a lunch break is planned from noon to 1 MT). Otter will have to declare by Nov. 16 whether Idaho will set up its own state-based exchange; default to a federally run exchange; or go with a partnership between the two. States do have the option to change their choice on that same date each year thereafter, presenting a fourth option: Start with a partnership, and transition toward a state-run exchange over time; a state-run exchange would allow Idaho to continue to control the regulation of its health insurance market.

Rep. John Rusche, D-Lewiston, said of the consultant's report today, “I think that they're saying what some of us have been saying for a while: That by dawdling, we've taken options off the table.” He said, “I'm not surprised - I'm disappointed.” But he noted that not all the information is in yet as far as whether Idaho could pull together some form of state-run exchange. “There are people that are still hopeful,” he said. Click below for a full report from AP reporter John Miller.

A private option for Idaho health insurance exchange?

Consultant Jack Grovner was asked by Gov. Butch Otter's health insurance exchange working group to look into whether Idaho could pursue a privately run model and still meet federal requirements under the health care reform law. The answer: Yes, if it comes through a state-established private non-profit corporation. That's a subset of the state-run exchange option; Idaho must decide whether to go with a state-run exchange, default to a federally run exchange, or go with a partnership between the two.

Rovner found that Idaho has a precedent for a private, non-profit model: Its Idaho Health Data Exchange, a non-profit created in 2008 to carry out the initiative started by President George W. Bush in 2004 to move toward a nationwide tech infrastructure for exchange of medical data. The Idaho Health Data Exchange, incorporated by state Health & Welfare Director Dick Armstrong, was designated by Otter in 2009 as the entity carrying out that initiative for the state, qualifying it to receive federal grant funds.

A similar model could be adopted for an Idaho state health insurance exchange, Rovner said; Hawaii already has gone that route. The non-profit could receive federal grant funds for set-up, but not for operations; the state could set it up so that the exchange would have to be self-sustaining through fees or assessments, and would receive no state taxpayer funding. Hawaii's private, nonprofit exchange already has received a $62 million federal grant for set-up.

“What Idaho did on that health data exchange is really the perfect template,” Rovner said. “This is an option that will work, if you're interested in it - it's legal.” Rovner will make a presentation to the working group this afternoon; you can read his memo here.

Sen. John Goedde, R-Coeur d'Alene, has been promoting the idea of a private option, but possibilities he raised earlier, including “renting” an existing exchange structure, or essentially contracting out the service to a private firm, haven't proven workable under federal requirements. Goedde called the private non-profit model “intriguing,” and said it may offer a path that's more politically appealing in Idaho. “I think we need to take a look at every viable option we've got,” Goedde said. “Idaho, I think, traditionally has been a state where they feel less government is better. And if we can move something into a nonprofit arena as a viable option, certainly we need to consider that.”

Last month, hopes for a private model dimmed after State Insurance Director Bill Deal addressed lawmakers on the Health Care Task Force; but Deal said he was addressing the prospect of using an existing outside firm. “Basically what I was saying was if you go out to the marketplace today, you cannot find a not-for-profit or even a for-profit organization that has all of the pieces that could come in and hire them to run an exchange,” he said. “There's just not one out there.”

Rovner said a private non-profit could be established by executive order, and wouldn't necessarily require legislative action. However, Deal said, “That's a political issue. … This has been such a controversial issue in Idaho,” that it might be better for lawmakers to weigh in. “I just think in the long haul, it would be a cleaner method of getting to a conclusion of what that exchange should look like.”

Legislation that was prepared last year, but never acted on, called for a quasi-governmental entity to oversee a state-run Idaho exchange, rather than a private non-profit. Deal said either way, a board would have to be set up and all the details determined as to how the exchange would work, and timelines are tight for that. “That isn't going to be set up like magic no matter what,” he said. “The timeline is our enemy.”

‘Impractical’ for Idaho to build its own health insurance exchange by deadline…

Gov. Butch Otter's health insurance exchange working group is meeting today; you can watch live here. First up, the panel is hearing a cost analysis report from consulting firm KPMG. Among the conclusions, KPMG project manager Robert Mitchell told the panel: “We believe it's impractical for Idaho to try to build your own exchange by Oct. 1, 2013.” He added, “There is a whole lot to be done.”

Other states that are much farther along still are wrestling with details, he said. Idaho faces a Nov. 16 deadline to tell the federal government whether it wants to go with a state-run exchange; a federally run exchange; or a partnership between the two. If it makes no decision, the state defaults to a federal exchange. A partnership could allow the state to maintain control of plan management and/or customer outreach components, and then, in the future, move toward a state-run operation, Mitchell said.

Medicaid expansion group wraps up meeting, agrees on principles…

As the governor's Medicaid working group wrapped up its meeting today, Idaho Health & Welfare Director Dick Armstrong said it was “nice to hear such agreement on many of these principles - that's very encouraging.” He said he'll work on “simple graphic illustrations of costs and impacts” to bring to the panel at its next meeting Oct. 23rd. “I believe we have added to our information base and understanding,” he said, including today's point that administrative costs of the current county medical indigency system haven't yet been included in cost estimates. “We're going to try to put a dollar savings to that, so that was a good find today,” he said. The next meeting may be the group's final one, Armstrong said, but it'll reserve a date for an additional meeting just in case. “It depends on what happens with the November election - we may be back,” he said.

Panel: Lay out costs, look at impact on businesses, health outcomes

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.”

Idaho’s current system ‘not working as smart as we could’ for uninsured

Mike Baker of the Idaho Primary Care Association is now briefing the governor's Medicaid working group on Option 3: Expanding Medicaid in Idaho. “You look at the numbers, and this thing, this problem is just ginormous,” he told the panel. But, he noted, “We're paying for a lot of these things right now. They're coming out of inefficient systems, they're probably being paid at higher rates. … I don't think we're working as smart as we could.”

He noted a reference earlier in the day to Idaho's medical indigency program as a type of “debtors' prison.” “There's funding available to help these folks in our community access the care that they need, and it's up to us to figure out how do we utilize what we're paying now … to cover the gap,” Baker said. “There are all these holes in the system.”

He said, “We all know at the end of the day we're going to have some folks that fall through the holes, no matter what program we put together, but the goal here is to reduce the number of people falling through those cracks. … reduce the cost of their care … and stop requiring other folks in the community” to cover the costs through cost-shifting.

Baker, who noted that he sees patients who are part of this population every day at the Kootenai County community health center where he works, said, “This really can work, and get us closer to the day where we can say, 'Access to health care is not a problem.'” He said, “We have 65 percent of patients in our clinic are uninsured.”

He shared data that for Idaho's mentally ill patients, 95 percent could be shifted to an expanded Medicaid, saving $11 million in state general funds. About 75 percent of AIDS Drug Assistance Program clients would qualify for the Medicaid expansion, saving the state about $800,000. Shifting the uninsured population from the state's indigency program to Medicaid would save millions both for the state and for county property taxpayers. “We know cost-shifting is occurring,” Baker said. “This should be a no-brainer decision.”

He told the panel, “If your neighbor is healthy and they're able to work, your community starts getting better.”

No easy way to redesign Idaho’s ‘unique’ medical indigency system…

Idaho Association of Counties head Dan Chadwick briefed the governor's Medicaid expansion working group on what's been designated Option 2 - Don't expand Medicaid, but redesign Idaho's medical indigency program. “I've talked to my peers around the country and they all scratch their heads,” Chadwick said. “There is no other state that does it the way we do it.”

He said there's no simple way to redesign Idaho's program - he describes it as a “scraper,” that would have to be scrapped and a new system developed from scratch. Possible elements of redesign could include standardizing claims processing and expanding utilization management and medical review, he said. But possible savings would be difficult to estimate - perhaps coming to 2 percent from efficiencies. Because the indigency program is incident-based, not eligibility-based - meaning a person is eligible for benefits only if their medical bills from a particular incident are more than they could pay off in five years - it's very difficult to predict costs, because there's no way to know when someone will get sick or be in an accident. “It's a really unique system,” Chadwick said.

“I don't think anyone think there is a silver bullet or a magic wand that's going to change this program,” Chadwick said. “Many of the providers and the counties really don't like this system. I think we'd all be happy to see it go away. … It's a difficult system to administer, and we don't know even where to start in terms of capturing the administrative costs for this.” You can read my full story here on the program, from the Sept. 9 Spokesman-Review.

The working group is now headed on a lunch break, and will discuss Option 3 - expanding Medicaid - when it reconvenes at 1:15.

Status-quo approach on Medicaid expansion carries big costs…

Discussing the first option before the Medicaid expansion working group today - no expansion of Medicaid, and no change to the current medical indigency program - state Health & Welfare Director Dick Armstrong noted, “Clearly no expansion … does not mean no work. There's a significant amount of effort that has to take place.” The current indigency program is facing fast-rising costs, he noted, with a significant offsetter of costs, the pre-existing conditions insurance program, or PCIP, expiring in 2014. Current estimates show the indigency program, now at roughly $60 million a year between state and county taxpayer funds, would rise to $92.2 million by 2020.

Armstrong said those estimates are conservative, particularly because Idaho's household income has fallen for the last three years, even as inflation has continued. “So households today simply are not able to support themselves as they have in the past.”

Sen. Dan Schmidt, D-Moscow, a physician, asked if those figures include administrative costs, and the answer was no. “These are the direct benefits paid, and not any of the administrative costs,” said Dan Chadwick, head of the Idaho Association of Counties. Armstrong said, “That's a great question. Right now, there are approximately 100 county employees engaged in this process of indigency, and that's a cost we have not thought about until just recently, and needs to be folded into some of these other scenarios.” Administrative costs include everything from processing applications to placing liens on applicants' property and collecting on those liens, when possible, to offset benefits paid out. Hospitals, too, are facing significant administrative costs for participating in the program, said Steve Millard of the Idaho Hospital Association.

Chadwick said, “Fifty-three hearings are being held today on indigent claims in our neighboring county. That includes hospital staff, county staff, attorneys, county commissioners, sitting there listening to all these claims. That's a whole lot of time and effort putting in for just one day. It's a big deal. It's a large cost.”

Armstrong noted, “Sixty percent of the cases that come before the counties are not accepted.” Millard said, “The costs don't go away, just because the state doesn't pay for them, or the indigent program doesn't pay for them.” Unreimbursed costs drive up premiums and costs for everyone, he said.

Exploring the options on a possible Medicaid expansion in Idaho…

Three options are up for examination at the governor's Medicaid expansion working group's all-day meeting today: Don't expand Medicaid and keep Idaho's current medical indigency/Catastrophic Health Care Fund program as-is; Don't expand Medicaid and redesign the existing indigency/CAT program; and the third option: Expand Medicaid. The population currently served by the state-county indigency program would virtually all be covered by a Medicaid expansion, which would be largely federally funded; the current CAT program is funded entirely with local property taxpayer and state general tax funds, to the tune of roughly $60 million a year.

Though each of the three options will be explored today, the panel won't pick one; that'll come later. First, today, the group is hearing a presentation on the Leavitt Partners report on the potentially eligible population. Still in the works is a report from Milliman, another consulting group, on the costs of each of the options. The working group will meet again Oct. 23 to get the numbers from the Milliman report.

State Health & Welfare Director Dick Armstrong asked the working group members to keep in mind the advantages and disadvantages of all three options today. Pros and cons of each option will be recorded and put into a spreadsheet for review. When those considerations plus the numbers from the Milliman report are before the working group, Armstrong said, “We will then be moving to recommendations.”

Medicaid expansion working group meets from 9-3 today

Gov. Butch Otter's Medicaid expansion working group meets today from 9 to 3 p.m. at the state capitol, to hear a presentation on a newly completed study and discuss Idaho's options on a possible Medicaid expansion. You can listen live here, and see the agenda here.

Consultant’s report outlines details of how Medicaid expansion would work

The Idaho Department of Health & Welfare has received its full report from consultant Leavitt Partners on potential expansion of Medicaid in Idaho under the Affordable Care Act. The governor's Medicaid expansion working group has scheduled a Sept. 27 meeting to review the report; click here for the full meeting announcement and links to the full report and its executive summary.

Among the report's findings: There's no deadline for the state to decide whether or not to expand its Medicaid program, and states can opt out of the expansion at any time. If Idaho decides to expand, the report recommends doing so in 2014, giving the state a full three years of 100 percent federal funding, and the option of opting out after those three years. That would require taking steps now to prepare, it notes. Other points in the report: Most of those who would become eligible for expanded Medicaid in Idaho have income of less than 100 percent of the federal poverty level - 75 percent fall below that level, and despite those low incomes, 64 percent are employed.

Idaho's existing Medicaid program offers no coverage to childless adults. Its current income limit for jobless parents is about 21 percent of the federal poverty level - that's $4,584 a year for a family of four - and for working parents, 39 percent.  The expansion would cover people with incomes up to 138 percent of the poverty line.

Prospects dim for private insurance exchange, regulatory issues raised with fed exchange

Idaho state Department of Insurance Director Bill Deal's update to lawmakers this morning on the progress of the governor's health insurance exchange working group included some eye-openers for legislators on the Health Care Task Force, from impacts of a federal exchange on Idaho's current insurance regulations to prospects dimming for a privately run option.

Sen. Steve Vick, R-Dalton Gardens, asked, “Do we have any idea yet how much flexibility (Idaho would have), with regard to what we can do differently in a state exchange than in a federal exchange?” Deal responded, “I would say we have some latitude in areas that I think are important to Idaho. An example would be how our producers are allowed to do business with an exchange.” He listed an array of things the state would retain in a state-run exchange, including its current regulatory authority over insurance companies and approval of rates and policy provisions. “Are you saying that if we go to a federal exchange, that we will lose the ability to regulate insurance companies in Idaho?” Vick asked. Deal said, “If we go to a federally facilitated exchange, we pretty much lose the authority to regulate the health insurance industry in Idaho.”

In response to questions from Sen. John Goedde, R-Coeur d'Alene, Deal said there are 782 insurance companies licensed to sell health insurance in Idaho, but only about 192 have done so. Idaho's premiums are among the lowest in the country, Deal said, and the state has the fewest mandates on insurance companies as far as what must be provided in their policies.

Goedde asked about an option he's pressed for, a privately run exchange, or a public-private hybrid, rather than a federally or state-run exchange. Deal responded, “I don't see that there's another option. … The hybrids probably aren't going to meet muster. … At our last meeting we talked a little bit about Utah. The last we heard is their hybrid might not work, and for sure they don't have an individual exchange that will be approved at this particular time the way they're approaching it.”

At the working group's next meeting tomorrow, it'll hear from officials from Colorado and Nevada to “get some updates on a fast way to move, if we should decide to,” Deal said. With a Nov. 16 deadline looming for Idaho to notify the federal government about its exchange plans, that might be a possible route, “if Idaho could participate with some of the infrastructure that they have in place,” Deal said. In October, the group will receive a consultant's cost-analysis study.

Lawmakers discuss possible Medicaid expansion

The Legislature's 14-member joint Health Care Task Force is meeting all day today at the state Capitol, and first up, it heard an update from state Health & Welfare Director Dick Armstrong on the progress of the governor's  working group examining a possible Medicaid expansion under the national health care reform law. Armstrong said a consultant's study that was expected to be out today has been extended to Sept. 14, “so we can get all the information we needed.” He said, “It is a very good document. I've of course seen the draft a number of times. It is very neutral, it is very factual.”

The population that would be included in a Medicaid expansion, he said, is made up largely of the working poor. “Sixty percent of those individuals are employed,” Armstrong said. “We do know this population has chronic disease, greater than the normal population, and we know what types of ailments that they suffer from, so it's very good data.”

Rep. John Rusche, D-Lewiston, noted that if Idaho doesn't expand Medicaid, it still will have “the statutory responsibility under the indigent program for care.” Armstrong responded, “Yes, if we don't expand, the existing statutes will stay in place in Idaho as far as how we handle indigent care.”

Sen. Joyce Broadsword, R-Sagle, said, “In my opinion we're still paying for those people whether they're going to be in the Medicaid program or not - we're either paying for them through Catastrophic Health Care plan, or through the prison system, or through hospitalization after the fact. So to me, Medicaid expansion is probably the way we need to go to make sure that we get the best outcomes.” Armstrong said the study will give the state “some numbers we didn't have before,” as to current costs for that population's health care and how it's being paid. “Their cost won't go away,” he said. “It is a matter of how do you manage that. … The question is what is it going to cost, and out of which pocket does it come.”

Sen. Dean Cameron, R-Rupert, task force co-chairman, cautioned that the state should look at the long term costs, 10 or 20 years out, as well as the shorter term. Armstrong said it's difficult to forecast medical inflation rates that far out, and the federal government is saying it will start by paying 100 percent of the cost for the expanded population for the first three years, phasing that down to 90 percent in six years and thereafter. But he raised the possibility that sometime in the future, the federal matching rate might fall to the 70 percent the feds now pay for the rest of Idaho's Medicaid program. “What we're being told by the feds is oh, no, the 90 percent will go on forever. Well, we know forever is not forever, it's as long as somebody's in office,” Armstrong said. Cameron said, “It's really easy for us to get caught up in the short-term cost savings. My fear is we'll have the short-term savings, and that will be spent in one way or another, and then 10 years, 20 years from now, not us but colleagues of us will be sitting around the table trying to figure out how to pay for this.”

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Betsy Z. Russell covers Idaho news from The Spokesman-Review's bureau in Boise.

Named best state-based political blog in Idaho for 2013 by The Fix

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