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Shawn Vestal: Idaho’s Medicaid gap provokes a deadly debate

UPDATED: Thu., Nov. 5, 2015

What does Idaho’s “Medicaid gap” look like?

Depends on your angle. In Kootenai County, it looks like nearly 7,000 human beings who can’t get health insurance. In Shoshone County, it’s about 800. Statewide, it’s 78,000 – the population of Coeur d’Alene plus Post Falls plus Rathdrum – all people who earn too much to qualify for Medicaid and too little to qualify for subsidized insurance, and who have been left hanging by Idaho’s lawmakers, who would rather spend more state and county tax money and deny their constituents health care than buckle to the tyranny of Obamacare.

What else does it look like? Most people in Idaho’s Medicaid gap work – 68 percent of uninsured households have at least one employed person. More than half have kids at home. You might wonder: Do they not get sick, these residents of the gap? Of course they do. But without insurance, they tend to go longer without care and thus get sicker, tend to ignore chronic problems until they reach a crisis, tend to wind up in expensive emergency services and tend to wind up costing state and local governments a lot of money.

That has been the conclusion of two special working groups of experts convened in Idaho, both of which recommended that Idaho expand its Medicaid program under Obamacare. Hospital officials and county commissioners – whose budgets are strained by indigent care – have urged the same. Idaho lawmakers, like those in 20 other red states, refused because a government-run health care program is like the Holocaust.

Is there any reason to hope that Jenny Steinke’s death might change their mind?

Steinke was a 36-year-old woman living squarely inside the Medicaid gap when she died in Idaho Falls last month following a severe asthma attack. She had been suffering worsening symptoms for weeks before she died, taking increasingly frequent hits off short-acting inhalers while waiting for the insurance from her husband’s new job to take effect so she could see a specialist, according to a story in the Idaho Falls Post Register.

Steinke had a severe asthma attack Sept. 1 and arrived at the hospital blue in the face and not breathing. Days later, she died. Her mother called it “death by poverty.” Her ER doc, Ken Krell, told the Post-Register that if she’d been able to get preventive care earlier, she likely would have been put on oral steroids and not even needed hospitalization at all.

“Several times a week I see people who have delayed medical care because they don’t have coverage, either Medicaid or insurance,” said Krell, who has been a public advocate of Medicaid expansion. “They put off being seen until it’s really dire. It’s a very common occurrence.”

Idaho lawmakers do not listen to people like Krell. They listen to people like Wayne Hoffman, the president of the Idaho Freedom Foundation. The IFF is a bogus charity that claims tax-free status as an educational institution, though its only educational effort seems to be teaching legislators how to vote.

Hoffman wrote a blog post last week lashing out at those who would draw a connection between Steinke’s death and the Legislature’s decision to keep the Medicaid gap open. He said that doing so was “a lie,” and part of a “desperation narrative,” and pointed out that, hey, get over it, people die.

“People in private insurance die, just as people on government programs or no program,” he wrote.

Lest you think Hoffman is simply ignorant and selfish, he wants you to know that he opposes Medicaid because Medicaid is bad for people’s health. He said that “several studies have found with great consistency that people on government health programs don’t necessarily do better than people on no program at all. … These reports all found, consistently, that patients would have been better off if they weren’t part of the federal government’s Medicaid system.”

The reports find no such thing. They make much more narrow conclusions about health outcomes in populations and find, unsurprisingly, that the Medicaid population is sicker and more troubled than average.

I asked Hoffman for some citations. They included: A University of Pennsylvania study showing slightly higher mortality rates and incidence of surgical complications for Medicaid patients than uninsured patients. A study in Florida showing Medicaid patients were more likely to have certain late-stage cancers at diagnosis – rather than being caught by earlier care – than the uninsured. A University of Pittsburgh study showing throat cancer patients on Medicaid had a far greater likelihood of advanced cancer at diagnosis than … people with private insurance.

Does Hoffman believe that Medicaid causes these outcomes?

I asked him this and he said no, then added: “… when you create an entitlement for which people are merely enrolled, there are other possible side effects, and not all of them good.”

So…. yes? Sounds like yes.

This is like concluding that homeless shelters cause homelessness. The Kaiser Family Foundation notes that the Medicaid population starts off with “distinctly higher rates of poverty, chronic illness and disability” than both the privately insured and the uninsured.

“A large body of studies over several decades provides consistent, strong evidence that Medicaid coverage lowers financial barriers to access for low-income uninsured people and increases their likelihood of having a usual source of care, translating into increased use of preventive, primary and other care, and improvements in some measures of health,” the foundation said in a 2013 report.

But the argument is not really about science. There is a form of magical thinking at work here, in which government of any kind – from a zoning regulation in Burley to a federal health insurance program – is a villain of Voldemortian proportions, so much so that Hoffman and the people who share his views can believe, or at least say they believe, that people are better off with no health insurance than they are with insurance that is tainted by government.

Wonder what Jenny Steinke would say about that.

Shawn Vestal can be reached at (509) 459-5431 or Follow him on Twitter at @vestal13.