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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.

Otter: ‘We’re prepared to sit down and find a path forward with all the stakeholders’

Idaho Gov. Butch Otter spoke with reporters this afternoon about the election results, and he said the call from “Students Come First” opponents to begin new talks with all stakeholders about school reform is “exactly what I want to do.”

“I think the interest that was shown on both sides, and what we heard on both sides, gives us a good opportunity to start developing, with everybody, a concurrent plan that we can go forward with,” Otter said. “I think everybody does realize, whether they voted for or against the propositions, that our old education system is simply not working. We're not graduating students in many cases that are ready for college, not ready for the wonderful world of work or careers. … I talked to some of the leadership this morning and we're prepared to sit down and find a path forward with all of the stakeholders.”

Otter said he'd be opposed to trying to just re-pass the same laws the voters have rejected. “That isn't a course that I think is positive, that isn't a course that I think would be productive,” he said. “I do think what we need to do is take each prop, each idea of reform, and sit down and say, 'What did you like about it? What didn't you like about it? If you had a chance to change it, how would you change it?' And those things that we can agree on, and each and every one of those … is what we ought to go forward with.”

Unlike Otter, Luna didn't talk to the press today. Asked about Luna's sentiments, Otter said, “I sense that he believes this is a new beginning on education reform, and that we're going to have to go forward.”

The governor said, “There is something we ought to be celebrating today, and that is the big turnout that we had in Idaho. … But we also need to celebrate the independence of the Idaho voter. The Idaho voter isn't going to be led anyplace without some rational thought on their own, without some investigation on their own. I have been the benefactor of that, and in some cases I haven't benefited so much from it. But I still love the independence, and I celebrate their independence today.”

He added, “I want to concentrate right now on the path forward. I want to vet that through the (legislative) leadership, say what can we accomplish, and how quick  can we accomplish that, and who do we have to have in the room to accomplish it.”

Otter on school reform: ‘The public conversation isn’t over, it’s only begun’

Idaho Gov. Butch Otter issued this statement today on the voters' rejection of Propositions 1, 2, and 3, the “Students Come First” school reform measures:

“The people have spoken, so I’m not discouraged. That’s how our system works. But it’s important to remember that the public conversation that began almost two years ago isn’t over – it’s only begun. Our workforce, our communities and most of all our students still deserve better, and our resources are still limited. We offered these reforms not because we sought change for change’s sake, but because change is needed to afford our young people the opportunities they deserve now and for decades to come. That’s as true today as it was yesterday, so our work for a brighter and better future continues.”

Ad Watch: Latest school reform commercial echoes earlier one

The latest TV commercial in favor of Propositions 1, 2 and 3 comes from “Yes for Idaho Education,” and features a message strikingly similar to that in a September statewide ad from “Parents for Education Reform.” The look is different, with video of teachers and kids in class, and there's different music, but the message is the same; it pulls out a feel-good item from each of the three complex measures and touts it as what the propositions will do. It does add in a jab at the “national teachers union” that was missing from the earlier ad. “It is essentially the same general positive message we’ve had in initial TV, in radio ads, and on our direct mail absentee chase,” said Ken Burgess, spokesman for the “Yes” campaign.

Click below to compare the wording of the new “Yes” ad and the previous ad from PFER, which was the group that placed the ads funded by secret contributions to Education Voters of Idaho; you can read my fact-check story here from Sept. 28, which was headed, “Ad touting school reforms tells just part of story.”

The  new “Yes” ad is running only in the Boise, Twin Falls, and Idaho Falls/Pocatello markets, Burgess said, adding, “We've left the Gov. Otter ad in place for our full run in Spokane.”

Ad Watch: Otter steps forward in latest school reform ad

The latest campaign ad in Idaho's school reform fight features Gov. Butch Otter endorsing Propositions 1, 2 and 3 in a positive, feel-good message. “Education in Idaho is at a crossroads,” the casually dressed governor says in the commercial, which is running statewide, including in the Spokane-Coeur d'Alene market. “This election year we're being asked whether we will keep meaningful education reforms on the books or go back to the old way of doing things.”

The “old way of doing things” refers to Idaho's laws prior to 2011, when lawmakers enacted the reforms that restricted teachers' collective bargaining rights, imposed a new merit-pay bonus system, and required big technology boosts including laptop computers for high school students and a new focus on online learning. “It paints the opposition as being reactionaries, going back to the old ways, which is kind of funny,” said Jim Weatherby, emeritus professor of public policy at Boise State University. “It's a pretty positive message.”

The ad is sponsored by “Yes for Idaho Education,” the official campaign group backing the three measures. Opponents of the laws collected thousands of signatures to force a voter referendum on the laws; a yes vote would keep them, while a no vote would repeal them. Ken Burgess, spokesman for the Yes campaign, said the idea behind the ad was partly to defuse ire aimed against state Superintendent Tom Luna, the author of the laws. “All this issue about these things being called the 'Luna laws' - we just want to remind everybody from a leadership, statesman standpoint that the governor was as much responsible for this stuff certainly as Tom Luna,” Burgess said.  You can read my full story here at spokesman.com, examining the claims in the ad.

Otter: First Lady Asked For Donation

Idaho Gov. Butch Otter says it wasn't him who asked New York Mayor Michael Bloomberg to donate to Idaho's school-reform fight — it was First Lady Lori Otter. “The first lady was the one that talked to Mike's organization,” Otter said today, before judging a children's Halloween costume contest on the state Capitol steps. “You know, we got to know Mike pretty well, going up to the, Herb Allen has his gathering up in Sun Valley, and so every year we've gone up, we've ran into Mike, and had an opportunity to kind of get to know each other. He's been interested in education, and Lori I think was telling him about it while we were up there, and he said, 'Give me a call, I'll see if I can help you.'”/Betsy Russell, Eye on Boise. More here. (AP file photo of Lori Otter & governor snuggling at a Republican victory party)

Question: Did Butch throw Lori under the bus?

Otter: First lady asked NY mayor Bloomberg to donate to Idaho campaign group

Idaho Gov. Butch Otter says it wasn't him who asked New York Mayor Michael Bloomberg to donate to Idaho's school-reform fight - it was First Lady Lori Otter. “The first lady was the one that talked to Mike's organization,” Otter said today, before judging a children's Halloween costume contest on the state Capitol steps. “You know, we got to know Mike pretty well, going up to the, Herb Allen has his gathering up in Sun Valley, and so every year we've gone up, we've ran into Mike, and had an opportunity to kind of get to know each other. He's been interested in education, and Lori I think was telling him about it while we were up there, and he said, 'Give me a call, I'll see if I can help you,' or give his organization a call, I should say, and he'd see if he could help us.” Bloomberg donated $200,000 to the secret-donations group Education Voters of Idaho, which today revealed its donors under a court order.

Otter said he was the one who made the pitch to Albertson's heir Joe Scott, who anted up $250,000. “And he was very gracious,” Otter said. “But he wanted everybody to know and to make sure that it was him personally,” as opposed to the J.A. & Kathryn Albertson Foundation. Both Otter and the first lady today were dressed in costumes consisting of academic caps and gowns, with the foundation's “Go On” slogan festooned on them, urging kids to go on to higher ed after college.

Otter said he did participate in a fundraiser for the school-reform campaign at the Republican National Convention that featured Jeb Bush. He asked how much EVI reported today that it had raised overall, and seemed pleased with the $641,000 figure, saying, “OK, good!”


The group was presented by its chair, Debbie Field, and co-executive director, John Foster, as a way to provide a voice for parents in the debate, but its donor list is heavy on businesses and organizations and out-of-state wealthy folks. “As far as corporations, those other organizations, remember they all have employees, and those employees have kids,” Otter said. “And they also want to look forward to tomorrow's workforce, and they know that a good education is an important part of that.”

Otter said he was fine with the donors being disclosed. “I think, look, that's the law,” he said. “No matter where you organize the organization … they've got to obey our laws. And that has been my position all along.”
  

Guv, first lady to host kids for Capitol trick-or-treating on Wednesday

Gov. Butch Otter and First Lady Lori Otter will host a free “Trick or Treat” party for children at the state Capitol on Wednesday, with trick-or-treating from 3:30 to 6 p.m. and a costume contest at 5:30. Prizes will be awarded for the best costume portraying an Idaho historical figure, a book or movie character, the scariest, and the most creative; click below for more information. The first lady also will hand out copies of her her children's book, “Ida Visits the Capitol.”

Otter Dedicates Dover Bridge

In this April 2008 SR file photo, the old Dover Bridge is seen in a rear-view mirror.  Looks like the ITD board is The North Idaho bridge received national attention as one of the worst in the country. Now it has been replaced. (SR file photo: Kathy Plonka)

The new Dover Bridge was dedicated this morning. Here's the story from this morning's Bonner County Daily Bee:Governor Butch Otter and other officials will be on hand today for a dedication ceremony for the new U.S. Highway 2 bridge in Dover. The ceremony starts at 11 a.m. beneath the bridge. Signs will be posted for parking and dedication site location. Dover’s Depression-era truss bridge was replaced a 72-foot-wide steel structure with no overhead encumbrances. The highway has been realigned and includes improved access into the city and a bicycle/pedestrian trail, the Idaho Transportation Department said. The project accommodates future expansion of U.S. 2 west of the bridge spanning the Union Pacific railroad to Rocky Point east of the bridge.” More here.

Otter: A ‘big day’ with Idaho company successful bidder for laptop contract

Gov. Butch Otter called this a “big day,” announcing that Hewlett-Packard Corp. has been named the successful bidder to supply laptop computers to Idaho high school students. “It's a proud moment for me,” Otter said, “that we had an Idaho company that was the successful bidder and that will lead us into that 21st Century classroom.”
  

Otter, Luna, HP officials gather at HP to announce ‘major partnership’ on laptop contract

Three Hewlett-Packard laptop computers are lined up next to a stack of battered textbooks, binders and a calculator today in a conference room at Hewlett-Packard Corp., where Gov. Butch Otter and state Superintendent of Schools Tom Luna are gathered along with dignitaries for the announcement of a “major partnership between HP and the State of Idaho:” HP has been selected as the vendor for student laptops under the “Students Come First” technology program.

On the big screen behind the laptops is the logo for Students Come First, Luna's reform program that calls for supplying every Idaho high school student and teacher with a laptop computer. The state has been in the final stages of negotiating an eight-year, $100 million-plus contract to supply the laptops.

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.”

Otter to bring ‘Capitol for a Day’ to tiny Pine, Idaho

Gov. Butch Otter has announced that he'll hold his next “Capitol for a Day” event in Pine a week from Friday. That's the same tiny town where Otter has a cabin, and that faced evacuation this summer, along with nearby Featherville, due to the Trinity Ridge wildfire.

“Pine is the kind of place where people from the city go to get away from crowds and breathe fresh air,” Otter said, “Now, wildfires have made it a lot busier and smokier than any of us would like this year. And for some of us, that’s more than an inconvenience, because Pine is home. I’m looking forward to hearing from my neighbors about the issues that matter most to them, and to letting them know their community and the independence it represents are important parts of the Idaho way of life.”

Otter will be at the Pine Senior Center on Oct. 19 from 9 a.m. to 3 p.m., including a noon luncheon with local officials and residents; among those accompanying him will be the state's directors of Fish & Game, Parks & Recreation, Insurance, Homeland Security, and Species Conservation, along with Lt. Gov. Brad Little and officials from the departments of Agriculture, Health & Welfare and Transportation.

Otter's been holding the events monthly, and has already held 59, including at least one in each of Idaho's 44 counties; his goal is to get to every county twice before he completes his current term.  Many have been in similarly small towns around the state; last month, he was in Nordman, on Priest Lake.

Otter Pal Raises $200K For Props 1-3

Debbie Field, Gov. Butch Otter's former drug czar and two-time campaign manager, has raised $200,350 from a single source and spent it on broadcast ads supporting Propositions 1, 2 and 3, also known as “Students Come First” and “The Luna Laws.” Field heads a new group, Parents for Education Reform, which filed its Sunshine report Tuesday, a day before the deadline for finance reports covering the period May 26 to Sept. 30. The new political action committee's treasurer is Cordell Chigbrow, who also is Otter's treasurer. All but $32 of the $200,350 raised was paid to Sandler-Innocenzi Inc., for broadcast advertising, which includes radio, TV and internet spots/Dan Popkey, Idaho Statesman. More here.

Question: Why is Gov. Otter and his followers so sold out to the Luna Laws?

Otter calls for more logging, grazing on public land to prevent wildfire

Idaho Gov. Butch Otter has sent out a guest opinion to Idaho newspapers this afternoon, blaming federal land management policies for this year's destructive wildfires and calling for change. Otter says the answer is more logging and grazing to reduce flammable fuels on federal lands.Despite the best efforts of our congressional delegation, Idahoans and all Americans will continue paying in many ways for the lack of direction – or misguided direction – that federal laws and policies provide public land managers,” he writes. “And while our exceptional firefighters put their lives on the line, the challenges they face on the ground are aggravated by litigious single-interest environmental groups devoted to economically undermining such traditional industries as ranching and forest products.”

Click below to read Otter's full article, which concludes: “It’s time for a new dialogue and a new approach to federal land management.”


  

Otter Speaks Out Vs Cyberbullying

Imagine a classroom of 25 kids — students facing the challenges of schoolwork and the awkwardness and peer pressure that comes with growing up. Now, imagine 720 classrooms. If you can envision that, you have a mental picture of the pervasive reach of cyberbullying in Idaho. Each year, more than 18,000 Idaho kids receive threatening texts or messages. The smartphone that is a must-have and a connection to family and friends also makes it easier for bullies to target victims — perhaps anonymously, often from a distance. The social networking sites that provide young people a virtual gathering place also provide a stalking ground for bullies. For many adults — no matter how much verbal abuse they saw or heard in school hallways or locker rooms — this new form of bullying is more difficult to comprehend/Kevin Richert, Idaho Statesman. More here. (AP illustration)

Question: Do you consider cyberbullying among juveniles to be a problem in Coeur d'Alene?


Read more here: http://voices.idahostatesman.com/2012/10/04/krichert/a_good_first_step_otter_speaks_out_against_cyberbullying#storylink=twt#storylink=cpy

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.

Otter Empathizes w/Chicago Mayor

In the struggle to fix the nation’s public schools, the old red-state, blue-state idea is looking as dated as Dick and Jane. You can hear the change in the voice of Gov. C. L. Otter, a Republican here in one of the most deeply conservative corners of the country, when he expresses a brotherhood bond with Rahm Emanuel, the Democratic mayor of Chicago and former Obama administration chief of staff. Students at New Plymouth Elementary play outside during recess. “I could empathize with Rahm and what he was going through,” Mr. Otter, better known as “Butch,” said about the recently settled teachers’ strike in Chicago during an interview here in the State Capitol. “It’s not the teachers,” Mr. Otter said, paraphrasing Mr. Emanuel’s tough-guy script from a news conference at the height of the standoff. “It’s the union bosses”/Kirk Johnson, New York Times. More here. (AP file photo: Chicago Mayor Rahm Emanuel)

Question: Would you call Idaho Gov. Butch Otter and Chicago Mayor Rahm Emanuel kindred spirits?

Keough: Cheers For ‘Capital’ Program

On my Facebook wall, state Sen. Shawn Keough commented re: Gov. Butch Otter's “Capital for a Day” program, which visited Nordman in the Priest Lake area Wednesday:

The over 200 Idahoans present at Nordman today appreciated that the Governor and several directors of state agencies as well as 2 other Land Board members took the time to spend with them. There was either and agency director or regional director from almost every state agency there. The attendees had questions throughout the entire day - from roughly 8:15 a.m until 2:00 p.m. Boise is @ 500 miles away from Nordman, and from my seat it looked like people there were glad they had a chance to talk to their elected officials and to heads of or regional directors of state agencies face to face. A rare opportunity for us and many that live here. Too rare in my view. Kudos to the Governor for his effort!

Question: Are you a fan of the “Capital for a Day” program?

Otter’s budget chief departs to head Associated General Contractors

Wayne Hammon, Idaho Gov. Butch Otter's budget chief for the past five and a half years, is resigning Sept. 28 to become executive director of the Idaho Associated General Contractors. Hammon, who heads Otter's Division of Financial Management, wrote in his resignation letter, “After serving as DFM administrator longer than any of my predecessors, it is now time for me to move on.”

The previous AGC executive director, Mark Dunham, resigned in June after suffering a stroke in January; he had held the position since 2007. The group has more than 600 members, and in 2011 Dunham described it as the state's “premier construction lobby” and “the premier voice for Idaho’s construction industry at every level of government.”

Hammon's been a lobbyist before; he served as director of government relations for the National Association of Wheat Growers from 1999 to 2001 after working as a congressional aide to U.S. Sens. Larry Craig and Orrin Hatch. Hammon also headed the USDA Farm Service Agency in Idaho for seven years before joining the Otter Administration. When he left the Wheat Growers, the group's president, Dusty Tallman, said Hammon “made our organization a potent lobbying force.” Hammon is the latest in a line of top Otter Administration officials who've left for positions lobbying state government, including two former chiefs of staff.

Hammon, 41, who holds bachelor's and master's degrees in public policy from BYU, said, “I count Butch Otter as a friend, and I'm honored that he trusted me with this job, and I'm happy to have been of service as long as I have. It really is an honor.” He said the opening at AGC was a “great opportunity” for him. “We're right at the beginning of a tremendous boom in the economy - I think the recovery is happening,” Hammon said. “So that industry's got a very bright future, and I'm excited to be part of that.” Late this afternoon, Otter issued a news release about Hammon's departure; click below to read it.

Payette Dispute Too Person For Guv

This morning's state Land Board agenda included a recommendation to approve a stipulation to settle the title for some property on the shore of Payette Lake on which a 1942 deed had incorrectly identified the property lines, including part of the lakebed, which the state owns. The owner, who acquired the property in 1981, filed a “quiet title” action, resulting in the stipulation to make the correction. But when it came time to vote, Gov. Butch Otter, who chairs the Land Board, said, “For the record, the chairman will not vote.” Secretary of State Ben Ysursa responded, “I had a hunch.” The property owner? Otter's ex-wife, Gay Simplot.

Thoughts?

State property line issue a little personal for governor…

This morning's state Land Board agenda included a recommendation to approve a stipulation to settle the title for some property on the shore of Payette Lake on which a 1942 deed had incorrectly identified the property lines, including part of the lakebed, which the state owns. The owner, who acquired the property in 1981, filed a “quiet title” action, resulting in the stipulation to make the correction. But when it came time to vote, Gov. Butch Otter, who chairs the Land Board, said, “For the record, the chairman will not vote.” Secretary of State Ben Ysursa responded, “I had a hunch.”

The property owner? Otter's ex-wife, Gay Simplot.

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.”