The Statehouse was teeming with physicians, city officials and citizens for the first Idaho Senate hearing on a bill to expand Medicaid to 78,000 uninsured Idahoans Feb. 2.
Sen. Dan Schmidt, D-Moscow, brought two bills before the Senate Health and Welfare Committee. Both propose a way to expand medical coverage to uninsured Idahoans using federal dollars.
Schmidt’s proposals are based on work group recommendations. Three years ago, a work group made up of lawmakers and physicians considered straight Medicaid expansion as suggested within the Affordable Care Act. Leavitt Partners, a Salt Lake City research firm, provided a demographic study of individuals who make too much to qualify for Medicaid, but don’t earn enough to qualify for tax subsidies through the state Health Exchange. Milliman, a national actuarial research firm that consults for business, nonprofit, government and education partners, provided a fiscal report.
The group then gave a unanimous recommendation to the Legislature to expand Medicaid, but it was never heard, Schmidt said.
In 2014, a working group analyzed the various ways other states had expanded Medicaid and worked to make an “Idaho plan” that subsidized premiums for private insurance plans. This plan became known as the Healthy Idaho plan, backed by Close the Gap Idaho, but action was never taken on it either.
Both plans were presented as alternatives to Gov. C.L. “Butch” Otter’s Primary Care Access Program, which proposed the use of about $30 million in state funding to provide basic health services to the 78,000 individuals in the gap. Otter unveiled his plan in his State of the State speech Jan. 11. The Healthy Idaho Plan was repeatedly touted as a better option at the hearing.
“I want to make this clear – I applaud Gov. Otter for seeking action on those who fell into this Medicaid gap,” said physician Ted Epperly,
CEO of Family Medicine Residency of Idaho. He testified in support of Healthy Idaho to the Senate Health and Welfare Committee Feb. 2. “But this plan eliminates wasteful programs, and, more importantly, saves and improves the lives of working Idahoans who fall into the coverage gap, live sickly and die younger.”
Several business advocates, such as the Boise Metro Chamber of Commerce, have argued for Medicaid expansion for years. Expanding coverage would save the state money and would help protect companies from the rising health insurance premiums associated with cost shifts from unpaid medical bills. But most of the testimony given at the hearing came from physicians who treat the uninsured and the uninsured themselves.
“Seventy-eight thousand Idahoans live in the gap and there is no dignity here,” said Michelle Gluch, owner of Kid Co. and a master’s degree student at Boise State University. “My story is not unique. Most of my friends fall into this gap. We are waitresses, construction workers and adjunct professors.”
The most rousing testimony came from physician Kenneth Krell, director of critical care at Eastern Idaho Regional Medical Center in Idaho Falls, who said that legislative inaction was responsible for the deaths of 1,000 Idahoans. That led the chairman of the Senate Health and Welfare Committee, Lee Heider, R-Twin Falls, to threaten the removal of the next person to “charge the Senate unfavorably.”
“I see those patients on a near-daily basis,” Krell said of uninsured Idahoans who can’t afford preventative care. “Dying often, because the disease processes are now at an end state and have resulted in organ failure.”
Krell’s testimony was based on his own experiences as a physician and from a study in the New England Journal of Medicine that concluded states that expanded Medicaid saw significantly reduced death rates, 19.6 fewer deaths annually per 100,000 adults.
“I could only come to one inescapable conclusion – that the Idaho Legislature is unfortunately responsible for those deaths,” Krell said. “Our intransigence in failing to pass Medicaid expansion for the last three years has probably resulted in over 1,000 deaths.”
The Healthy Idaho Plan and PCAP vary greatly in services and cost. PCAP provides primary services such as regular checkups. The Healthy Idaho Plan covers that and more, including prescriptions, hospitalization, and many specialized treatments associated with diseases such as diabetes and cancer.
The Healthy Idaho Plan pays for the expansion of Medicaid through $590 million in federal tax revenue while contributing about $30 million more in state contributions. The difference in state costs between this plan and PCAP, though, rises from Healthy Idaho’s recommendation to shut down county and state indigent plans. That would save Idaho about $56 million, according to Close the Gap Idaho.
One such indigent program, the catastrophic medical care program, uses state general funds and local property taxes to cover medical costs for patients who can’t pay the bill off in five years and cost more than $50 million in four of
the last five years, according to the Legislative Budget Book.
Heider said he didn’t want to hold a vote on the Healthy Idaho Plan because the committee hadn’t yet heard from Otter on PCAP. Regardless, nearly everyone who testified asked the committee to approve the Healthy Idaho Plan.
“I think this is the most important public policy decision in the state of Idaho by far,” said Boise Mayor David Bieter.
Democrats have tried to move on Medicaid expansion several times recently, but have failed to get traction. At the hearing, citizens and politicians urged the committee to put away political ideology while considering what is best for the state.
“As a politician there have been times I was told if I go through with something it would be the end of my political career,” Bieter said. “I can say that in 17 years that was never true. Sometimes it was told to me as a threat and sometimes it was told to me as advice. I really urge you to pass this bill.”
Heider searched the room for someone with a dissenting opinion and found Fred Birnbaum, vice president of the Idaho Freedom Foundation. Birnbaum argued that the Healthy Idaho savings wouldn’t necessarily happen as forecast. The savings are based on existing federal and state Medicaid contribution levels, only 10 percent of which are paid by the state. If the ratio changed, Idaho might see its savings disappear, Birnbaum said.
“The savings that are projected are based on thin air in my opinion because we simply don’t know what future Congresses are going to do,” Birnbaum said.
About 60 people signed up to testify, but less than a dozen were allowed to do so before Heider ended the hearing. With no motion, the proposed bills stay in Schmidt’s hands — so it is possible they will return to the committee for a hearing or vote.