Latest from The Spokesman-Review
State lawmakers may not consider Medicaid redesign options even if they save lives and money, lawmakers on a state Medicaid redesign work group said Wednesday, because the idea of Medicaid expansion is politically “toxic,” the AP reports. Click below for a full report from AP reporter Kimberlee Kruesi.
AP reporter John Miller reports that Republicans today dampened expectations about broadening Medicaid health care eligibility this year for poor Idaho residents on the same grounds they balked in 2013: Before taking extra federal money, the existing system should be overhauled to encourage beneficiaries to take personal responsibility for their health. Meanwhile, the state worked last year to get “verbal approval” from the U.S. Department of Health and Human Services to deviate from existing Medicaid programs for newly covered residents, to help meet Otter's goals, Idaho Health & Welfare Department spokesman Tom Shanahan told the AP, but the state would have to actually agree to expand Medicaid before seeking a formal waiver. That's unlikely to happen soon, Shanahan said, since expansion discussions have largely ended. “Unless the state says it's going to do it, we really can't apply,” he said. Click below for Miller's full report.
Idaho’s biggest business lobby, the Idaho Association of Commerce and Industry, has come out in favor of Medicaid expansion, a move that could save the state budget more than $600 million in the next decade and save county property taxpayers $478 million. In a letter to Gov. Butch Otter dated Friday, IACI President Alex LaBeau called for re-convening Otter’s task force on Medicaid redesign – which last year recommended the expansion, along with various changes to the Medicaid program – to look at how best to accomplish it.
“IACI supports Medicaid redesign in a manner that is fair to taxpayers, beneficial to employers, adds provider accountability, addresses the inherent inefficiencies in the county indigent program and the state’s catastrophic program, and minimizes the cost shift to business,” LaBeau wrote, reporting the group’s official position, adopted by its board in September; you can read my full story here at spokesman.com.
LaBeau is among the speakers at a forum tonight at the Boise Public Library entitled, “Opportunities & Obstacles of Medicaid Expansion;” also speaking are Jim Baugh, executive director of Disability Rights Idaho; Rep. Tom Loertscher, R-Iona, the conservative eastern Idaho lawmaker who last year introduced legislation to expand Medicaid; and Corey Surber, executive director of community health and public policy for the St. Alphonsus Health System. The free forum starts at 7 p.m.
The expansion in question would cover under Medicaid adults who make up to 138 percent of the poverty level, roughly $31,000 a year for a family of four; that originally was a mandatory part of the Affordable Care Act, also known as Obamacare, but the U.S. Supreme Court made it optional for states. Idaho Medicaid now covers non-disabled adults only if they have children and have income of less than 20 percent of the poverty level, or $4,584 for a family of four.
When Idahoans who fall into that uncovered category and have no health insurance run up catastrophic medical bills, whether it’s from accidents or cancer, a county-state program steps in to help with the bills, with county and state taxpayers paying 100 percent of the tab. Liens are placed on everything the patient owns, though little is generally recovered. If Idaho opted to expand Medicaid to cover that same population, the federal government would pay 100 percent of the costs for the first three years, then phase down to 90 percent.
LaBeau said his organization is intrigued by a program that’s been approved as a demonstration project in Arkansas, where the state will take the federal Medicaid expansion funds and use them instead to purchase private insurance for those individuals. “It’s more of a private-sector solution,” he said, adding that Iowa has a similar program awaiting approval. “We certainly think it’s worth taking a look at,” he said.
Last year, Idaho lawmakers declined to take any action on the issue.
Idaho has so far balked at expanding Medicaid coverage for more low-income residents, part of President Barack Obama's insurance overhaul left optional for states by the U.S. Supreme Court, but the Idaho Department of Health and Welfare doesn't want to get caught flat-footed, just in case lawmakers and Gov. Butch Otter decide otherwise, Associated Press reporter John Miller reports. So for just over a month, Health and Welfare has been quietly asking private insurance companies for details about how they'd go about providing expanded Medicaid coverage for roughly 104,000 adults who earn less than 138 percent of the federal poverty line.
Companies have until Wednesday to submit their feedback. “Basically, we want to be ready, if and when Idaho decides to expand,” said Denise Chuckovich, Health and Welfare's deputy director in charge of Medicaid. Click below for Miller's full report.
KidsCount, the organization that tracks various measures of children’s well-being, is highlighting a concern about the impact of a failure to expand Medicaid on Idaho families: A coverage gap that would develop when middle-income families qualify for tax credits to help them get insurance coverage in 2014, but low-income families wouldn’t. That’s because the national health-care reform law anticipated that lower-income families would be covered through Medicaid expansion, which the law originally made mandatory for all states; the U.S. Supreme Court overturned that, saying states can decide whether to expand Medicaid or not. The AP reports that 23 states and the District of Columbia have announced they’ll expand Medicaid; 18 have declined and nine are undecided. Idaho is among the undecided, for now.
Idaho KidsCount put together an infographic to demonstrate the gap; you can see a full-sized version here. It shows two fictional Idaho families of four, one with a household income of $31,680, the other, $23,155. The higher-income family would qualify for a $10,206 tax credit toward the $11,209 annual premium to cover both the family’s adults. The lower-income family would get nothing to help with that cost, in the absence of Medicaid expansion, though the kids in both families would be covered.
“Idaho’s families want to have the security of knowing they can get the health care they need without facing devastating medical bills,” said Lauren Necochea, Idaho KidsCount director. “We also want our state to have laws that are fair to everyone and don’t play favorites. Accepting the Medicaid dollars would bring Idaho closer to those goals.” You can see KidsCount’s full statement here.
Large Idaho employers would face millions in costs if the state declines to expand its Medicaid program, according to a new report from the Idaho Association of Commerce and Industry. “For us, it's a business-numbers issue,” IACI President Alex LaBeau told Idaho Statesman reporter Audrey Dutton. “It's pretty clear from the information and the numbers that Medicaid expansion would save industry a lot of money.”
Dutton reported on IACI's findings over the weekend; click below for a full report from the Statesman and The Associated Press. Idaho Gov. Butch Otter convened a working group a year ago that studied the issue and recommended expanding Medicaid, but only if the move is accompanied by reforms in the program; Idaho took no action this year, but still could. The working group found that the state, counties and Idaho property taxpayers would save hundreds of millions if Medicaid were expanded; the move, initially 100 percent federally funded then scaling back to 90 percent, would replace the state's current medical indigency program, which is 100 percent funded by county property taxes and the state general fund.
OLYMPIA – Washington’s new state budget signed into law this week relies on the expansion of Medicaid, both to provide health insurance to hundreds of thousands of people and to help balance its bottom line.
But state residents will have to wait until October to sign up for that coverage, and until next January for it to kick in. State officials agree that the program isn’t well understood yet, but say a major information campaign is coming to help people understand how it works and who will qualify.
In general, anyone whose annual income is below 138 percent of the poverty level, will be eligible for free health care under Medicaid…
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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.”