Three years ago this month, an Idaho Workgroup on Medicaid Expansion finished its work with the emphatic conclusion that expanding Medicaid would save the State of Idaho money over the next decade, and Idahoans would be healthier if they could access care before their maladies became so acute they could no longer put off seeing a doctor.
Nothing came of that work, although Gov. Butch Otter did convince legislators to launch an Idaho health insurance exchange that has reported phenomenal success connecting low-income residents with insurance plans.
Still, 78,000 with incomes too high to qualify for subsidies remain uninsured, so the head of the workgroup is shopping a plan that avoids state conscription into the expanded Medicaid system, but provides only the most basic care: no drugs, no hospitalization, no emergency room visits.
But for the Obamacare-impaired, it also avoids the odious necessity of accepting federal support for the more expansive coverage of the therapies that are driving health care costs in the United States far beyond those of other developed countries.
Instead, Otter and the Idaho Department of Health and Welfare proposes doubling Idaho’s 57-cent-per-pack cigarette tax, which would raise about $30 million, which breaks down to about $32 per month per person.
Imagine what $32 per month would purchase in the way of medical care, and how many providers will be willing to see patients with so little assistance. The plan also envisions “medical homes” to which patients would be assigned for care. Homes allow patients to establish on-going relationships with doctors, clinics or other providers who can assure a continuity of care impossible with episodic visits to emergency rooms.
Homes are a good idea, if owners can keep the doors open.
Idaho, like Washington, does not have enough primary health care providers to go-round, a fact noted in the workgroup report. The effect of an additional $30 million on a state health care system that in 2012 received $1.14 billion in federal Medicaid support will be negligible.
And Idaho’s non-smokers might pick up the habit because the new plan will not relieve taxpayers of the burdens they carry at the county and state level to care for the indigent, one of the most attractive aspects of expanded Medicaid, which would save the state an estimated $173 million over 10 years.
Still, even this most modest of proposals has only tepid support. Though Idaho’s cigarette tax would climb to only the 19th highest in the U.S. if the alternative plan is adopted, anti-tax legislators are already suggesting the necessary funds be found elsewhere.
And there is competition for cigarette revenues. A group called StopTuitionHikes.com has filed a ballot measure that would raise tax by $1.50 per pack, and dedicate most of the revenues to lowering tuition at state colleges.
Although we have suggested legislators at least allow that group to try to gain the required signatures, basic health care comes first. The $30 million proposal is inadequate, but it’s a start.
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