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Saturday, October 19, 2019  Spokane, Washington  Est. May 19, 1883
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Eye On Boise

Legislative leaders say Idaho’s work to close health coverage gap isn’t ending

Idaho state Capitol dome (Betsy Z. Russell)
Idaho state Capitol dome (Betsy Z. Russell)

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By Betsy Z. Russell

BOISE – The work of the Legislature’s study panel examining alternatives to close Idaho’s health coverage gap isn’t over, legislative leaders said Friday, even though President-elect Donald Trump is vowing to repeal Obamacare.

“I don’t believe that is dead,” said House Speaker Scott Bedke, R-Oakley. “I don’t think the problem has gone away.”

Senate President Pro-Tem Brent Hill, R-Rexburg, said, “I certainly do not believe that all their work has been in vain.”

The joint legislative panel has its final meeting set for Nov. 22, when it’s planning to finalize its report and recommendations to the Legislature. It’s charged with examining alternatives for the 78,000 Idahoans who make too little to qualify for the state’s limited Medicaid program, but not enough to qualify for subsidized health coverage through the state’s insurance exchange. Those Idahoans make less than 100 percent of the federal poverty level.

Under the Affordable Care Act – also known as Obamacare – Medicaid originally was supposed to expand to pick up that gap population, which largely consists of the working poor. But after the U.S. Supreme Court ruled that that move was optional for states, Idaho has continued to debate it, and hasn’t decided whether to expand its Medicaid program, though expansion would have come largely at federal expense.

The 10-member legislative working group has “learned some good things,” Hill said. “They’ve learned what the needs are, what some of the costs and limitations are, far beyond a traditional Medicaid expansion – which we knew was not going to go anywhere in Idaho anyway.”

Bedke earlier this week told the Twin Falls Times-News that Medicaid expansion is no longer on the table in Idaho, saying, “No sense in working on the branches of a problem if the root is going to be pulled up.”

But Bedke said the working group’s charge remains. “I think they have identified some state money that could be spent more effectively and more efficiently,” he said.

Hill said Idaho’s existing medical indigency and catastrophic care program, which pays medical bills for people facing catastrophic expenses who can’t pay up, and then puts liens on their homes and everything they own in usually unsuccessful attempts to get reimbursement, is “already costing the citizens of Idaho tens of millions of dollars.” He said, “Let’s find a better way to use that.”

Rep. Luke Malek, R-Coeur d’Alene, pointed to the health care reform priorities outlined on President-elect Trump’s transition website, “They say they want to work toward a patient-centered health care system that promotes choice, qualify and affordability, which is exactly what that group has been talking about,” Malek said. “And they want to maximize states’ flexibility in administering Medicaid, which is also exactly what that group has been talking about.”

“We have a good model in the state of Idaho to manage cost and make sure that everyone has coverage and access, and do it from an Idaho-based level,” Malek said. “So I think it actually provides a lot of opportunity.”

House Minority Leader John Rusche, D-Lewiston, who lost his re-election bid this week, said he already thought Medicaid expansion was unlikely in Idaho. “Even prior to the election, I thought it would be a very difficult thing to get the House Republican leadership, particularly … to saliently move forward on that issue,” he said.

Sen. Dan Schmidt, D-Moscow, who like Rusche is a physician and like Rusche also lost his re-election bid, said, “The majority party took a very firm stance. I just want to compliment the governor for the state-based exchange. I think that was a great idea, and it worked real well.”

At Otter’s urging, lawmakers approved a state insurance exchange for Idaho, which has helped nearly 100,000 Idahoans obtain insurance, most with federal tax subsidies. But after approving the exchange, lawmakers stopped short of Medicaid expansion, saying they didn’t want to cooperate with Obamacare.

Schmidt, who with Rusche was among the leaders of the push to expand Medicaid in Idaho, said, “Trying to make the market forces apply to health care is a monumental task, and I applaud the governor for doing that with the state exchange.”

He said, “I have no idea what the Republicans want to do or what Trump wants to do. This campaign was very short on details – a lot of rhetoric, not many details. And I’m kind of a detail person. I’d love to see the plans. Maybe they’ve got one.”

Schmidt said Idaho’s State Health Innovation Plan, or SHIP project, has been working to reform both health care delivery and payment models, to shift Idaho’s health care system to a patient-centered medical home model in which care is coordinated and prevention is stressed; and providers are paid for keeping people healthy rather than just treating the sick.

“Most people in health care know this needs to happen,” Schmidt said. “It’s going to take some leadership.”

Schmidt said the United States spends 18 percent of its gross domestic product on health care, without making its people healthier. “If we can’t have the courage in this country to face the issue of health care costs, then I’m not sure we’re a sustainable economy,” he said. “I wish people saw that. The public lands issue? I don’t believe that’s putting our next generation in peril. But I do believe health care costs are.”

Bedke said he wants the legislative working group to “inform themselves and maybe update the committee at least in a general way on the direction the new administration is going to go.”

Hill said, “They know what the political environment is out there, and I’m sure they’ll take that into account as they make their recommendations.”

Said Bedke, “If any of the rhetoric is accurate coming from the administration-elect, anything we do will not be built upon a platform of the ACA as we know it.”

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Betsy Z. Russell
Betsy Z. Russell joined The Spokesman-Review in 1991. She currently is a reporter in the Boise Bureau covering Idaho state government and politics, and other news from Idaho's state capital.

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