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Spokane, Washington  Est. May 19, 1883

Lawmakers to scrutinize Health and Welfare

 (The Spokesman-Review)
Betsy Z. Russell Staff writer

BOISE – Idaho lawmakers are about to take an unusually close and detailed look at spending in the state Department of Health and Welfare, the state’s largest agency and home of its fastest-growing costs.

“There are things out there that we need to take a hard look at,” said Sen. Shawn Keough, R-Sandpoint, vice chair of the Joint Finance-Appropriations Committee and co-chair of a subcommittee that studied Health and Welfare over the summer.

As a result of the subcommittee’s work, the joint budget committee will spend all of next week examining the department’s budget, rather than just a single morning. The panel also will reach out to the Health and Welfare committees in the House and Senate – because they, and not the budget panel, should decide whether to make changes in programs, Keough said.

“Whether we’re spending too much or not enough, I don’t think I have that answer yet,” Keough said. “My goal is to make sure that the people that need the services, truly need the services, get it.” But that must happen in an “efficient and cost-effective manner,” she said. “There’s some oversight that could happen that we’re not doing, that could give us some better controls.”

Keough’s subcommittee is recommending that the House and Senate Health and Welfare committees look into such possibilities as co-payments, premiums, other types of cost-sharing, clinical review of whether individual patients really need services, and limits on numbers of visits or spending caps for certain services, from chiropractic care to psychiatric care.

“We need to look at some of those cost-containment measures,” Keough said. “I don’t think we should do that in JFAC.”

In past years, budget-oriented reforms have been proposed by the joint budget panel, angering recipients and providers of services because JFAC is the only legislative committee that takes no public testimony.

Medicaid, the federal-state program that provides health coverage for poor and disabled Idahoans, is the fastest-growing portion of the state budget.

Sen. Dick Compton, R-Coeur d’Alene, the new chairman of the Senate Health and Welfare Committee, said, “One thing I’ve learned, if your whole objective is to cut costs, you’re going to have a tough time. You can look to control costs, and you can look to make sure the services you’re offering are services that provide the greatest good and the greatest (participation).”

But Compton said his panel has another, equally important objective: “To provide quality health care for those who cannot provide for themselves.”

“In Idaho, particularly in a lot of our rural areas, there are people who without some of the help that they get through Medicaid … would be in terrible straits,” Compton said. “I hope we never lose sight of the fact that there are some folks out there that really do need help from the state.”

Keough’s subcommittee spent long hours over the summer delving into every part of the Health and Welfare operation, and hearing details about how the department is organized and what services it provides.

“Having that time to explore the depths of the budget gave us a better understanding and appreciation for what the department does and the people that it serves, and I think that helps us make better decisions,” Keough said.

Another of Keough’s subcommittee’s recommendations is that many members of the joint budget committee – not just one, as in the past – sponsor and explain pieces of the Health and Welfare budget in the full House and Senate. That will force more members of the key committee to become intimately familiar with the huge department.

Rep. Maxine Bell, R-Jerome, co-chairman of the joint budget panel, praised Keough and her subcommittee for their work. “We’re all on the same page in trying to be the most efficient, the best we can in this area – we just keep struggling forward,” she said.