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Spokane, Washington  Est. May 19, 1883

Gov. Otter proposes $30M plan for Idahoans in health coverage gap

BOISE – Idaho Gov. Butch Otter is proposing a new $30 million program to provide basic medical care to the estimated 78,000 Idahoans who now fall into a coverage gap, making too much to qualify for Medicaid but too little to qualify for subsidized health insurance through the state health insurance exchange.

Those Idahoans have gone without any health coverage for the past three years, since lawmakers refused to expand Medicaid to serve them, as Washington and many other states did. Close to 100,000 higher-earning Idahoans signed up for insurance plans through the federal Affordable Care Act, most of them getting subsidies.

Otter’s Medicaid Redesign Task Force has been calling for Medicaid expansion for the past three years, but the measure has been a non-starter in the heavily Republican, anti-Obamacare Idaho Legislature – even though the federal government would bear the vast majority of the cost.

“We haven’t had the political will,” Otter told reporters Thursday. “There’s always some resistance to starting a new program, to expanding a program, and especially a program that’s initiated by the federal government. … I can understand that resistance.”

But he said his plan shouldn’t generate the same resistance, because it will be funded entirely by the state – the federal government would contribute nothing, and have no say.

“We’re going to do this at home; it’s the Idaho solution,” Otter said. “Is it more expensive? In the long run, probably not, but in the short term, yes, it is more expensive to do it, but it’s Idahoans taking care of Idahoans.”

The plan calls for Idahoans age 19 to 64 who fall into the gap – earning less than 100 percent of the federal poverty level and not qualifying for any other health insurance – to enroll at a participating clinic in their area, where they’d get an initial health assessment and an ongoing plan for addressing their health care needs.

It’s a “patient-centered medical home” program, a managed-care approach that focuses on coordinating care that’s appropriate for each patient’s needs. Fees for services would be charged on a sliding-fee basis according to income; the state would pay the clinics $32 per patient.

Not covered: Hospitalization, emergency room care or specialty services. But the program would provide basic preventive, physical and mental health care at the clinics, including managing chronic conditions such as diabetes and asthma, basic labs, X-rays and medications, and limited office-based behavioral health services. Patients may also qualify for discount prescription cards.

Otter’s proposal drew immediate support from the chairmen of the House and Senate Health and Welfare committees and top GOP legislative leaders, and even some support, with reservations, from the Senate’s Democratic minority leader.

“Not doing anything is not an option, as far as I’m concerned,” said Senate Minority Leader Michelle Stennett, of Ketchum. “It’s unfortunate that people had to have died from manageable illnesses and be in the paper before we started paying attention. … That there is a political will and commitment is a huge first step.”

She added, however, “I have to question the price tag … and the fiscal responsibility of this.”

Idaho would save hundreds of millions of dollars in state funds if it simply expanded Medicaid - money that now goes to indigent and catastrophic health care for the uninsured. Otter’s program won’t provide full coverage for those in the gap and would cost the state $30 million a year.

Senate President Pro-Tem Brent Hill, R-Rexburg, said, “It’s not lost on us that we’re dealing with people’s lives here, this is a real issue, this is a serious issue. And it’s not lost on us that this doesn’t go as far as the original Medicaid expansion.”

But, he said, “This does not preclude us doing something more in the future. … I realize that there are pressures on the budget everywhere, but $30 million, for what we’re getting out of it, it seems like a pretty good investment to me.”

Reaction from health officials was mixed.

“This proposal is an initial step, but it is an incomplete solution,” said Brian Whitlock, president of the Idaho Hospital Association.

Dr. Ted Epperly, CEO of the Family Medical Residency of Idaho, said it’s “only a partial plan that provides limited benefits.”

The money – all state funds – would come from Idaho’s existing cigarette and tobacco taxes, with some of the programs now funded by that tax revenue shifting to the state general fund.

Otter noted that Idaho’s state tax revenues are growing. “We will not be increasing taxes anywhere,” he said, noting that state revenues have been coming in on or ahead of forecasts.

Otter, who unveiled his proposal to reporters at Thursday’s annual AP Legislative Preview event, will lay out his agenda and proposed state budget to lawmakers on Monday in his State of the State message to a joint session of the Legislature, kicking off Idaho’s annual legislative session, which is expected to run through March.