The 'No' in 'No-Brainer'

Idaho's anti-federal stance is starting to cost millions

April brings daffodils, tax pay-up day and weary Idaho legislators back from Boise, home to stay.

To their credit, in the just-concluded legislative session, Idaho legislators did push through the difficult birth of a state health insurance exchange. The delivery was long and contentious. After a combined 16 labored hours of House and Senate debate, all parties were exhausted — nobody, it seems, was up for taking on another caucus-wrenching battle.

But the legislators should have lingered longer.

Left to die in the House Health and Welfare Committee, unexplained and undebated, were two bills that would save taxpayers of Idaho millions of dollars, create hundreds of new jobs and bring medical care to thousands of Idahoans.

Instead, the legislators walked away from even considering Medicaid Expansion, a proposal under the Affordable Care Act, which would pay 100 percent of the costs of newly eligible Idahoans for three years, beginning in 2014. After 2017, states would contribute 5 percent of expanding costs of those newly eligible, and after 2020 no more than 10 percent.

Far too many Idaho legislators turn their back on accepting federal dollars, especially those delivered through the Affordable Care Act. In the eyes of the anti-feds, clean tax dollars that Idahoans sent the Internal Revenue Service this month somehow turn dirty upon arrival at the IRS office. This extreme distrust of our federal government by flag-waving “patriots” is a baffling phenomenon.

All but one of the states surrounding Idaho — Washington, Oregon, Montana and Nevada — are on board the Medicaid Expansion train. Not so for Utah, other assorted red states and a predictably solid row of Southern states.

Ironically, Idaho has more to gain from accepting Medicaid dollars than most other states because of the strange, expensive way Idaho deals with its medically needy.

Let me try to explain Idaho’s current system: Let’s say that my mythical Idaho Cousin Mabel, living in Nampa with no health insurance, is in a serious car wreck and spends weeks in the hospital being stitched and glued back together. All the while, Cousin Mabel is piling up bills that she can’t possibly pay within five years.

Mabel can take those bills to the Canyon County Courthouse and apply for help. If approved, Canyon County will pay the first $11,000 of her medical bills, and send the rest off to Boise for the state to pay from the General Fund.

The strange thing about this system is that payment is episode-based on bills accumulated after a heart attack, surgery or cancer treatment. Mabel has not necessarily found a medical home to provide preventive advice and support. It’s emergency-based medicine — the most expensive kind.

In 2012, the costs to Idaho’s county and state taxpayers for helping the medically indigent through this unique Idaho system was close to $70 million dollars, with no federal match to ease the pain.

Repeat: $70 million!

Officials estimate that 90 percent of Idaho’s medically indigent, like Cousin Mabel, would qualify for Medicaid under the expanded eligibility. That population would include uninsured adults between the ages of 18 and 64 who have an annual income under 138 percent of the federal poverty level. (That’s $15,415 for a single adult and $31,810 for a family of four.)

Idaho’s very costly system of using the counties as gatekeepers has worked surprisingly well in the past. I have several friends who have been caught by a medical calamity and have been rescued by the county. They end up paying back $50 or so per month for the rest of their lives and do so gratefully without a grumble.

But the county system and the state Catastrophic Fund have outlived their usefulness. They are breaking the bank.

The second bill that was left unheard in the legislative committee would have abolished the outdated and bankrupt Catastrophic Fund. It’s time for the Cat Fund to go, and to take advantage of the available federal Medicaid Expansion funds.

The Idaho Hospital Association, the Idaho Medical Association and 46 other nonprofits have published a summary sheet endorsing the Medicaid Expansion. They claim Idaho’s adoption of the Medicaid Expansion plan would provide health care coverage to 150,000 uninsured Idahoans and save up to $84.6 million in state funds.

Put simply, sticking with the status quo without accepting federal funds will help fewer medically needy Idahoans and cost us all millions more.

When the report of Governor Otter’s working group came out recommending that Idaho endorse the Medicaid Expansion based on the superior medical landscape the federal dollars would help create, House Minority Leader and medical doctor John Rusche, D-Lewiston, declared “It’s a no-brainer.” I agree.

I sincerely hope that Governor Otter will heed the advice of his working group, give Medicaid Expansion his blessing and start persuading Idaho’s reluctant legislators.

It is time for Idaho to rejoin the Union. 

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