SB 1142a, Sen. Marv Hagedorn’s $10 million health gap bill, has failed in the Senate on a 13-22 vote, after a debate spanning nearly two hours; you can read my full story here at spokesman.com.

Hagedorn said the bill is the result of an interim working group that examined options for the state’s gap population, the 78,000 Idahoans who earn too much to qualify for Idaho’s limited Medicaid program, but not enough to qualify for subsidized insurance through the state’s health insurance exchange. Among the working group’s recommendations were that the 2017 Legislature take action to provide some kind of health care to some portion of that population. It also recommended that if Idaho accepted federal Medicaid expansion funds, it enact a conditional “sunset” expiration clause in case federal policies change. “This is not that,” Hagedorn said.

Instead, he said, the bill would tap $10 million in tobacco settlement funds to cover about 15,000 of the most chronically ill among the gap population with coordinated primary care, and also would steer people who come to emergency rooms inappropriately into coordinated care programs.

“We are all paying for these costs today,” Hagedorn said. “Nothing is free.” He said, “This sets up a foundation of coordinated care for the chronically ill gap population. It doesn’t cover everything.” If they get cancer or need surgery, he said, that’s what the state’s existing catastrophic care program is for.

Hagedorn said the program would provide care, not insurance.

Sen. Maryanne Jordan, D-Boise, said she wanted to acknowledge Hagedorn’s work on the issue, “because it’s unbelievably important to Idaho.” She said, “My concern with this bill is twofold. One is I believe what we’re doing with this bill is articulating processes that in one way or another are already in place.” She read from an email from a primary-care physician with Terry Reilly Health Clinics saying federal programs already cover primary care through community health centers, but don’t cover cancer treatment, surgery and the like. Secondly, Jordan said she was concerned about the Millennium Fund as the funding source, because it “will strip away funding” for existing programs, from the Project Filter anti-tobacco program to the Idaho Suicide Hotline. “I think we have a long way to go in this issue, and many more robust debates to have in the future, but sadly I don’t think this gets us there,” she said.

Sen. Jim Patrick, R-Twin Falls, said it’s not often he agrees with Jordan, but this is one instance. “I have a hard time supporting this legislation,” Patrick said. “For one thing, $10 million is a drop in the bucket,  it’s going to take $100 million.” Plus, he said he’s concerned about cutting funding for the existing programs that get grants from the Millennium Fund each year, including the Boys & Girls Clubs. “Not knowing what’s going on at the federal level ... I don’t think it’s enough money to do hardly any good and it’s taking away from existing programs.”  

Sen. Steven Thayn, R-Emmett, said, “Behaviors have to change, life choices have to change if we are going to reduce medical costs.” Thayn said he thought the bill was the right move. “Why use state funds? It’s pretty simple – so we can write our own rules,” he said. “There’s no hospital coverage in this bill – that’s true. But that does not mean … that if the federal government decides to do block grants, we cannot say, let us pay for the primary care side, you help us with the hospital side. … Passing this bill does not mean we won’t deal with that issue in the future. It simply means we’re going to start with the foundation.” He said, “It’s a small beginning, but I don’t know of any other idea out there besides expanding Medicaid, and my fear is if we don’t act, we will have Medicaid expansion with federal rules that don’t work for us.”

Sen. Lee Heider, R-Twin Falls said, “Ten million dollars is a lot of money. … For years we worked on the SHIP grant,” which was a $40 million federal grant aimed at shifting health care in Idaho from a fee-for-service approach to a patient-centered medical home model. Heider said that’s a good project and it’s working. “Therefore I think the $10 million we’re looking at here is somewhat redundant,” unless it’s simply added to the SHIP project. Heider said he believes the Trump Administration is looking at solutions. “I think we’re a little premature,” he said. “The Department of Health & Welfare is working hard to take care of these issues. … I think we need to just sit tight and use what opportunities are available today to help these people in the gap population.”

Sen. Mary Souza, R-Coeur d’Alene, urged support for the bill. “I believe that our health care system in the United States is upside down,” she said. “We focus on illness, illness pays very well, and there’s a big revenue stream. … If we are going to improve our lifestyle here in Idaho, we are going to have to flip that model upside down. ... Improve the level of people’s wellness, rather than just feeding the illness machine.” She said the bill would start the process of “innovations” that Idaho’s health care system needs.

Sen. Patti Anne Lodge, R-Huston, said even with the bill, there still would be money from the Millennium Fund available for some other programs, such as Project Filter.

Hagedorn, in his closing debate, said, “These aren’t deadbeats. These are people who have jobs. … And they have health problems.”

“We need to encourage these patients, these participants, to get healthy,” he said. “At the same time we need to bend the cost curve. ...This is not a cure-all, totally granted, not a cure-all. But this sets the foundation for people to get healthy. There are people dying right now, people dying today, because they don’t have health care. So weigh this. Where’s it better to spend our Millennium money? … To help chronically ill people that don’t have insurance get well – that’s the focus of this, nothing more.”

Here’s how the vote broke down:

Voting yes: Sens. Agenbroad, Bayer, Davis, DenHartog, Hagedorn, Hill, Keough, Lakey, Lee, Lodge, Siddoway, Souza, and Thayn.

Voting no: Sens. Anthon, Bair, Brackett, Buckner-Webb, Burgoyne, Crabtree, Foreman, Guthrie, Harris, Heider, Johnson, Jordan, Martin, Mortimer, Nonini, Nye, Patrick, Rice, Stennett, Vick, Ward-Engelking, and Winder.