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An empty chair stood next to Gov. Butch Otter as he spoke today to the Associated Taxpayers of Idaho. "I apologize for this chair up here," Otter told the crowd. "The lieutenant governor asked me if I was going to pull a Clint Eastwood, and I said, 'I was there - I don't think so." His comment drew a laugh.
Gov. Butch Otter, in his luncheon address to the Associated Taxpayers of Idaho today, challenged county commissioners to bring him a list of state-mandated services they provide that they'd like to do away with. "I'd be remiss if I didn't open the floor to the question of what are we going to do about personal property taxes," including proposals to eliminate them. "I've made no mystery of the fact that I've been a supporter of that," Otter said, "but I also understand how 44 counties … the question is always what are you going to do with that share of our budget which we get in our counties from personal property tax, and I said frankly I don't know." He said, "I want to engage in those discussions."
He said the budget will be challenging in the upcoming legislative session, and the latest tax revenue figures are forcing a downward revision in projections. "I will tell you we do not have a placeholder for $130 million in that budget," to offset elimination of the personal property tax. "We will have those discusssions, and I hope that we can come up with a plan. … I understand the plight of the counties, when it represents in some counties upwards of 35 percent of their budget."
Otter said two years ago, he asked for a list of "those things which you think you can do without in your county that we mandated, and I'll be your champion to get rid of those services, to stop those services and to relieve you from that financial burden, because I understand that. But I have yet to see the list."
Idaho Gov. C.L. (Butch) Otter has six years in office under his belt and two more to go. But what does he have to show for it? To say he has the thinnest legacy since Gov. (Big) Don Samuelson would be taking an unfair poke at Samuelson. Idaho's 25th governor, Samuelson served from 1967 to 1971. He generally rates near the least successful governors. He was a terrible public speaker. He suffered comparisons to his predecessor, Robert Smylie, and his successor, Cecil Andrus. And the voters denied him a second term. By contrast, Otter is an exceptional retail politician who has won three terms in Congress, two as governor and could have a third for the asking. But in terms of governing, Samuelson's record is not insignificant/Marty Trillhaase, Lewiston Tribune. More here. (AP file photo of Butch Otter at the end of 2012 Legislature)
Question: What has Butch Otter accomplished in his 6 years as governor?
Idaho Gov. Butch Otter has decided to delay a decision on how to proceed on a health insurance exchange in Idaho, now that HHS chief Kathleen Sibelius has agreed to give governors more time; a decision had been due today, but now the deadline has been pushed back to December. Click below for Otter's full announcement.
“I have my working group’s recommendation, and I have been listening carefully to stakeholders and citizens about this important choice," Otter said. "This extension gives us more time to get answers from HHS about what the federal requirements will be.” Otter noted that he consulted with other GOP governors at a Republican Governors Association meeting in Las Vegas this week from which he just returned today. “I don’t want us buying a pig in a poke," he said, "so with this extension I’m hoping we’ll get answers to the questions and concerns we’re hearing from legislators and the public.”
HHS gives states more time on health insurance exchanges, not clear if Otter will decide tomorrow or delay…
In response to a request from the Republican Governors Association, U.S. Secretary of Health & Human Services Kathleen Sibelius has sent out a letter giving governors extra time to make their decisions on how to proceed on health insurance exchanges - a decision for which the deadline was looming tomorrow. Last week, Sibelius gave governors until December to file the "blueprint" that will flesh out the details of the decision, but didn't move the Nov. 16 deadline for a "letter of intent" declaring the state's decision. If states don't opt to set up their own, state-based exchanges or enter partnerships with the federal government, the feds will take over and operate the exchange for those states.
Idaho Gov. Butch Otter has been considering the decision, and convened a working group that studied the issue for months, then recommended overwhelmingly that the state go with a state-based exchange operated by a private non-profit. Otter is at the RGA meeting in Las Vegas today, where the issue was among the discussion topics, and his office just received Sibelius' letter late this afternoon. Otter's press secretary, Jon Hanian, said, "I think over the next 24 hours you should know whether or not we're going to make some decision tomorrow or take additional time." You can read Sibelius' letter here.
The Idaho Community Action Network, a statewide non-profit advocacy group with more than 2,000 members, issued a report today calling strongly for Idaho to expand its Medicaid program to cover the working poor. That also was the unanimous recommendation of a 14-member working group appointed by Gov. Butch Otter, which studied the issue for months.
"It's the right choice for Idaho - it's going to save us money, and it's going to save lives," said Terri Sterling, the group's organizing director. "When you think about the families this is impacting right now, it's very sad across the state. … I have interviewed lots of these families, and it's so heartbreaking and heart-wrenching to hear some of these stories."
ICAN's report, "Invest in a Healthy Idaho," calls a Medicaid expansion "a prescription for ending the drain on state and county resources and creating financial stability for Idaho's patients." It highlights the stories of several Idahoans who lack health insurance, including Aaron Howington, who works, but much of his income goes to child support payments; he lives in a camper in the back of his pickup truck, can't afford health insurance and makes too much to qualify for Medicaid. "Without good health, I may not be able to continue working," he said. "I don't know what I would do then. The Medicaid expansion would allow me to get the care that I need to stay healthy and keep my job."
States have the option of expanding Medicaid, the state-federal program that provides health insurance to the poor and disabled, to cover the working poor under the national health care reform law, largely at federal expense; a decision from Otter and state lawmakers on which way to go is pending. In Idaho, an expansion would save the state hundreds of millions over the coming years, because the state currently covers the catastrophic medical bills of indigent residents entirely with county property taxes and state general funds.
Kelly Anderson of Boise said she hopes the state chooses expansion. "Right now I have several bills that are in collection due to not having insurance and needing medical care," she said. "Once they expand the Medicaid and cover people that aren't covered, I think you'll see a whole lot less emergency room visits that don't get paid for because people can't afford them, and I think you'll see a healthier country." Said Alecia Clements, an ICAN state board member, "I have good insurance, thanks to God, but a lot of Idahoans don't." If Idaho doesn't expand the program, she said, "It's going to cost us anyway, even more - I hope that our legislators understand that."
ICAN was formed in 1999 through a merger of the Idaho Citizens Network, a citizens' advocacy group focusing on the concerns of low-income residents, and the Idaho Hunger Action Council.
Idaho Gov. Butch Otter is reaching out to the opponents of the failed "Students Come First" school reform laws, including the leaders of the Idaho Education Association; they've been invited to an initial meeting with the governor's staff tomorrow. "I can confirm there is going to be a meeting," said Jon Hanian, Otter's press secretary. Otter won't be there himself, as he's attending a Republican Governors Association meeting in Las Vegas today through Thursday at which governors are discussing their options on health care reform in the wake of last week's election, but Otter will be represented at tomorrow's meeting by his senior special assistant on education, Roger Brown.
"This isn't about a specific bill or piece of legislation - it's about a conversation and developing a road map on how we can continue improving our education system," Hanian said. "This will be the first formal meeting since the election. We started reaching out to them last week." Hanian said the governor plans to reach out to all stakeholders on school improvement, after the overwhelming voter rejection last week of Propositions 1, 2 and 3. "The people spoke," Hanian said, as far as those measures. "We need to continue discussion about improving our education system in the state."
Corey Surber, chair of the governor's Medicaid expansion working group, said, "At this point I'm sensing consensus, but I'd like to do one more check." She asked working group members, if they didn't agree with Option 3 - expand Medicaid - with the identified caveats about benefit design, personal accountability and the like - to turn on their microphone lights. None did. That means it's unanimous - the group is backing Medicaid expansion for Idaho.
Still to be finalized is the group's formal report to Gov. Butch Otter, which will be word-smithed and completed over the next few days. You can read my full story here at spokesman.com.
Here are some of the working group members' comments as they debate options for Medicaid expansion in Idaho:
Sen. Patti Anne Lodge, R-Huston, said, "This would be good for our people in Idaho. But we also … don't know what the future's going to hold, and we don't know what the federal government is going to do with its $16 trillion deficit and the fact that they're going to be putting bigger burdens on the states." She said, "I'm not quite there totally. I know it's good for Idaho, but I'm very concerned about what this burden is going to place upon our people."
Dr. Ted Epperly said he's "strongly in favor" of expanding Medicaid in Idaho. "Really what we have an opportunity to do here is shape a new health care system and a new insurance program. … I love a benefit redesign that really puts a lot of personal accountability and incentivization onto patients for their health." He added, "I think we need to focus on what we can control, and what we can control is what we do here in Idaho with this program. … It's a real opportunity for us."
Dan Chadwick of the Idaho Association of Counties said, "The CAT program, the county indigent program, has run its course. It's time for it to end in this state because it has not done its work. It's becoming financially and administratively unsustainable."
Tom Faulkner said Idaho's now paying 100 percent of the costs for health care for the working poor from its state general fund and from county property taxpayers. "If we could have 90 percent to 100 percent of that paid by the federal government, why wouldn't we do it?"
Beth Gray said, "The data that's been presented today seems to me to be overwhelmingly compelling."
Gov. Butch Otter's Medicaid expansion working group is now considering what recommendation to make to Otter. Member Mike Baker spoke out in favor of expansion. "There's financial benefits, there's the opportunity to do something right here," he said. "From the state perspective, you look at the numbers, you look at the things we've learned through these discussions, and I think it's great - a great opportunity for us to put together a different model." He said he hoped Idaho could develop an appropriate benefit plan that would fit the state and the targeted population, and provide the appropriate incentives.
Rep. Fred Wood, R-Burley, said he's concerned about "how to control costs and how to bring the best medical care at the cheapest cost to patients in that population. And that we do get away from the perverse incentives in the American health care industry that are going on today, we get away from fee for service medicine, we get away from the old traditional managed-care concept. We actually have to get a system whereby the consumers and the providers … actually own the system, as opposed to feeding off the system. If we're going to go down that road, then I can wholeheartedly endorse the concept." But, he said, "If we're going to just have another entitlement program … then no, you don't have my support, nor do I think you'll have the Legislature's support." Said Wood, "We aren't just signing a blank check. That's not what we're about. We're about doing it right or we're not going to do it."
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.
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."
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.”
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."
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.
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?
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."
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."
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.
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."
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.
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."
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.
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?
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."
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?
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.
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."
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."
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.