Sen. Dan Schmidt, D-Moscow, a physician and an outspoken advocate of expanding Idaho's Medicaid program to replace the current county-state medical indigency and catastrophic care program, has sent an op-ed piece to Idaho newspapers saying, “The Idaho legislature adjourns with unfinished business. As health care reform moves forward, Idaho will have 100,000 people, many working poor without health coverage unless they have a catastrophic illness or injury. Then county taxpayers will pick up the bill, after the injured is found indigent, liens are filed and bankruptcy ensured.”

Schmidt writes, “We currently pay for health care for this population in an inefficient way,” and says, “We have work to do.” Click below for his full article.

Idaho Democratic Party Chairman Larry Kenck says Republicans in the Legislature are scared  to take up Medicaid expansion bills because they fear “blowback from their ‘return to the gold standard’ faction.” With Friday’s hoped-for adjournment dashed by Wednesday’s Senate defeat of the K-12 budget, Kenck urges citizens to pressure lawmakers over the weekend to reconsider and agree to take up two bills that a state-commissioned study estimates would save property taxpayers $478 million over 10 years. The expansion would add federally subsidized health insurance for about 100,000 low-income Idahoans, lifting the burden from county taxpayers. Delaying six months beyond Jan. 1, 2014, will cost taxpayers an estimated $41 million, according to Gov. Butch Otter’s Medicaid Expansion Workgroup/Dan Popkey, Idaho Statesman. More here.

Question: Are Republican legislators too afraid to take up an issue that will help the state's poor but alienate the noisy Fringe Right in their party?

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.”

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.

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.”