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Will Idaho's Governor Convince Lawmakers to Expand Medicaid This Year?

Stymied for three years by conservative lawmakers unwilling to expand Medicaid, Idaho Gov. C.L. "Butch" Otter on Thursday proposed a new state program to provide partial health care services to an estimated 78,000 uninsured adults.

By William L. Spence

Stymied for three years by conservative lawmakers unwilling to expand Medicaid, Idaho Gov. C.L. "Butch" Otter on Thursday proposed a new state program to provide partial health care services to an estimated 78,000 uninsured adults.

Otter's Primary Care Access Program, announced at an Associated Press legislative preview meeting, would offer clinic-based preventative health care services to Idaho's "gap population" -- those adults who earn too much to qualify for Medicaid but too little to qualify for subsidized insurance premiums through the Affordable Care Act.

"We want to begin the discussion on what we believe is an Idaho solution to our inability the last three years to provide for those in the (Medicaid) gap," Otter said. "Is this a total solution (to their health care needs)? I'd be misleading you if I said it was. But it is an effort we will put forward with the Legislature."

The total cost of the program is estimated at $30 million per year. The state would partner with local community health centers -- such as Latah Community Health in Moscow or the Lewis and Clark Health Center in Lewiston -- and other interested providers, paying them $32 per month per patient to serve as a "medical home" for uninsured adults. The goal is to provide consistent access to medical professionals to address the individual's health care needs before things reach a point where they have to go to an emergency room.

"We realize people in this gap population truly don't have access to ongoing sustainable health care," said Idaho Department of Health and Welfare Director Richard Armstrong. "We've evolved this concept to deliver them basic, primary care on an enrollment basis. They would enter the program, attach to a clinic, and the clinic would be responsible for delivering patient-centered health care. It will lift their condition from marginal to healthy."

The monthly fee would cover an initial health evaluation and medical checkup. Patients would also have access to basic primary care services and prescription medicine. The program would not, however, pay for hospitalization or specialty care. Patients would also be responsible for a portion of their health care costs, based on a sliding scale tied to income levels.

Armstrong said about 60 clinics in the Idaho Primary Care Network have indicated a willingness to participate in the program, and the state is having conversations with another 40 or so clinics.

"This is not a fee-for-service program," he said. "We wouldn't be paying individual bills. This will provide money to the clinics so they can expand capacity and add employees to help manage these folks going forward."

The 2016 session begins Monday with Otter's State of the State address.

The governor tried to get some movement on the Medicaid issue last year as well. In his 2015 State of the State, he encouraged lawmakers to consider the recommendations of his Medicaid Redesign Workgroup, which after two years of work supported expanding the program's eligibility income limit to 138 percent of the federal poverty level -- as provided for by the Affordable Care Act -- while simultaneously encouraging people to take greater responsibility for their own health.

The Legislature, however, declined to even hold hearings on the working group's report.

"We haven't had the political will -- and I understand that," Otter said Thursday. "There's always resistance to starting a new program or expanding one. But the pushback we've had, the caution that's stopped us from going forward, was let's not be dependent on federal money for any more programs in Idaho. This (access program proposal) is our answer to that. It's not a federal program; it would be totally controlled by the state -- our laws, our management."

It would also be paid for with Idaho dollars. Rather than raise taxes, Otter is proposing that the $30 million be shifted to the general fund from the existing tobacco and cigarette tax revenue stream.

Tobacco and cigarette revenues currently amount to about $45 million per year. The money goes for a wide variety of purposes, including a politically popular aquifer recharge program, the Permanent Building Fund, the Water Pollution Control Fund, public school substance abuse programs and school bond levy equalization, juvenile probation services and a cancer registry program.

The willingness of lawmakers to shift those dollars to a new program will likely determine the fate of the proposal, Armstrong said.

"I've talked with well over three-quarters of the legislators, and I'm not hearing any concern about the value of delivering primary care (to the gap population)," he said. "But there will always be an argument about the highest and best use of those dollars."

Following Otter's comments, Senate Minority Leader Michelle Stennett, D-Ketchum, questioned the fiscal responsibility of his proposal.

Rather than promote a plan that costs Idaho taxpayers an additional $30 million per year, she said, why not simply expand Medicaid? That would not only provide greater medical coverage -- compared to the partial services available under the access program plan -- it would also eliminate the need for the state catastrophic care program, which costs Idaho taxpayers about $50 million per year.

What Otter is suggesting, Stennett said, is that Idahoans "still pay into Medicaid and pay for the (catastrophic health) fund, and now pay another $30 million for a new program."

Health care organizations around the state had a similar reaction. For example, Neva Santos, executive director of the Idaho Academy of Family Physicians, described Otter's proposal in a news release as "a partial solution to address the needs of the 78,000 Idahoans without affordable health care coverage. While investing in primary care is useful, it won't provide the needed diagnostic treatment options to keep patients out of the emergency room or from costly hospitalization."

(c)2016 the Lewiston Tribune (Lewiston, Idaho)

Caroline Cournoyer is GOVERNING's senior web editor.
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