Arrow-right Camera

The Spokesman-Review Newspaper The Spokesman-Review

Monday, February 17, 2020  Spokane, Washington  Est. May 19, 1883
Partly Cloudy Night 31° Partly Cloudy
Opinion >  Editorial

GOP should consult states for a health care checkup


Republicans need a second opinion on Obamacare. They should check with their governors.

This week, for the umpteenth time, the GOP majority in the U.S. House of Representatives voted to repeal the Affordable Care Act. The Senate did the same last month by suspending rules that blocked a filibuster by Democrats.

President Obama vetoed the bill yesterday. Republicans do not have the votes to override, but that does not matter. What counts is the signal that, together with a Republican president, they can kill Obamacare; erasing his legacy.

And denying 15 million Americans the health care they receive thanks to the ACA, and snuffing out the hopes of millions more who cannot access the program. Their governors and legislators will not expand Medicaid despite the federal commitment to pay 100 percent of the cost initially, and 90 percent thereafter.

Idaho is a good example.

Your Health Idaho, the state’s health insurance exchange, has been a tremendous success, enrolling far more residents than projected. So far, 93,000 people have signed up for private plans for 2016, and the enrollment period remains open through the rest of the month.

But insurance remains out of reach of another 78,000 residents who make too much to qualify for subsidies, but cannot access Medicaid.

Thursday, Gov. Butch Otter announced he would submit to the Legislature a Plan B that will cover an initial health examination and health plan prepared at a medical “home” that becomes their long-term care provider. The emphasis, properly, would be preventative care that catches disease before treatment costs soar.

Participation will be voluntary.

Much of the care will be handled by the state’s 60 community health centers and 38 rural health clinics. They will not have much money to work with: $32 per month per patient.

The expensive hospital, specialty and emergency room care that drives the cost of health care in the United States to crippling heights will not be covered, which means that Idaho and county indigent funds will continue to pick up those bills.

Otter estimates the estimated $32 million annual cost of the Primary Care Access Program — PCAP — can be managed out of tobacco tax revenues. Growth in other revenues should pick up the costs of programs that receive that money now.

One of the best features of PCAP are its reporting requirements. With that data — which will not reveal individual records — the state will be able to track treatment outcomes. Outcome-based medicine is one of the best hopes for controlling costs.

From the point of view of Otter and like-minded Republicans, PCAP’s best feature is its non-reliance on federal money, and conditions. Still, it was encouraging that Senate President Pro Tem Brent Hill did not rule out more steps beyond those proposed by Otter.

“It’s not lost on us that we are dealing with people’s lives here,” Hill said.

What a wonder it would be if a single Republican leader in Washington, D.C., uttered those same words.

To respond to this editorial on-line, go to and click on Opinion under the Topics menu.

Subscribe to the Morning Review newsletter

Get the day’s top headlines delivered to your inbox every morning by subscribing to our newsletter.

You have been successfully subscribed!
There was a problem subscribing you to the newsletter. Double check your email and try again, or email