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Unfinished business in the Legislature

The Idaho legislature adjourns with unfinished business, and Idaho businesses should take note. Lowering health care costs serves us all, and Idaho should get to work on this. At the same time, we could lower property taxes and improve the health of our workforce. We needed the political will and we failed.

Last year counties paid about $40 million in property tax funds for indigent health care. This is money paid to hospitals and doctors after the injured or ill are determined unable to pay, liens are filed and bankruptcy ensured. If the cost per case is more than $11,000, the state pays the remainder. Last year, that cost Idaho taxpayers $35 million in general fund dollars. Almost all these people, plus an estimated 100,000 more, could have insurance coverage if Idaho chose to revise and expand Medicaid coverage as allowed and funded through the Affordable Care Act – yes, Obamacare. And that right there might explain the political reluctance. The numbers are clear. But this should be about more than just numbers. This needs to be the right choice for the long run.

I understand the fear of expanding an entitlement program. As a family doctor, I have always encouraged the appropriate use of services. If my patients, my neighbors or my family act irresponsibly, they hear from me. Health is something for which we can all take some personal responsibility. To control costs, we cannot just do things as we have always done.

Gov. C.L. “Butch” Otter’s work group concluded that more of the same old Medicaid program wouldn’t suit this population or Idaho. So, a unique benefits package was proposed that enrolls this group in a plan with co-pays and a health savings account. We believe this is part of the process to improve the health of our workforce and control health care costs.

This group of uninsured reflects the working poor in Idaho. Most work the equivalent of full time and have good health. We want to encourage their wise use of healthcare. They will get primary and preventive care in a doctor’s office, not in the emergency room. They will be healthier and more productive. We want them to put the pressure of their wise consumption onto our rising health care costs. They can contribute, as we all can, to the solution.

The Idaho legislature has further directed The Idaho Department of Health and Welfare to begin managing Medicaid costs through changing how providers are paid. The indigent care plan pays the bills after services are provided with little ability to control costs. Managing the care, rewarding efficient service and putting providers at risk for costs will bend the cost curve.

The maximum benefit to Idaho begins January 2014, and for every six months of delay, the state loses $45 million in cost offsets, so the clock is ticking. The Legislature had a chance this session, and we didn’t have the courage or take the time to act.

Health care costs are crippling our economy and clouding our future. We cannot control costs after the care has been given. Enrolling these Idahoans, managing the costs, and holding patients and providers accountable can start Idaho down a different path. If we as a state don’t have the courage to take on this problem, then we aren’t behaving responsibly. We still have work to do.

Sen. Dan Schmidt, D-Moscow, is a family physician. He served on the governor’s work group to study the expansion of Medicaid, and he sits on the Idaho Catastrophic Health Care Board.

About Dan Schmidt