House Blocks Medicaid Redesign

It’s election season and the Idaho Republicans are afraid to do anything to anger the Tea Party/Glenn Beck/Fulcher/Chmelik/Denney/Labrador faction. Nevermind that we are talking about saving the lives of about 100 Idahoans a year (say Professors from Harvard Medical School). Nevermind that we are talking about saving a half a billion dollars in county taxes over the next decade.

But, no, it is much more important to get re-elected than to entertain the idea of taking the federal tax dollars that we pay anyway and putting them toward Idahoans.

Here is the press release from Rep. John Rusche, who introduced a Medicaid Redesign bill today only to have it shot (followed by his testimony):





Idaho GOP  Blocks Medicaid Redesign Bill


Boise,Idaho–The GOP committee members of the House Health and Welfare Committee voted today to block consideration of a Medicaid Redesign bill in the Capitol. The bill was presented by Dr. John Rusche, of Lewiston, who is House Minority Leader.

Committee members who opposed the bill did not voice disagreement with the need for health coverage. However, they claimed it is not the right time.

“This is a month before the deadline for filing for Republican primary elections,” said Rusche, noting that there is considerable opposition from Republican leadership and the governor’s office.

My priority is improving the health and survival of Idaho citizens,” said Rusche. “As well as providing significant financial savings to the counties and the state. We are missing an opportunity.”


Rep. Rusche’s testimony:

Thank you Mr. Chairman and committee. I understand that Medicaid coverage is a difficult issue for many of you to face this year, but it is of great impact to the State and the citizens of Idaho.

I would like to talk about the importance of covering the working adults who are not eligible for subsidized health insurance through the exchange. And then of the foreseeable consequences of inaction. Then I will go through this very simple bill, almost identical to one printed by this committee last year.

Idaho is a low wage state. We have heard that we have the highest rate of minimum wage jobs, that our mean household income is 50th (of 51) in the country. When translated into the realm of health insurance, that means there are a lot of Idahoans who qualify for subsidized health insurance.

It is estimated that about 75% of Idaho households earn below 400% of the FPL, the upper limit of earnings for exchange subsidies. But there is also a lower limit of income, a floor amount, required for exchange participation. Because of the US Supreme Court decision and the State’s inaction, about 80,000 to 100,000 Idahoans earn too much for Medicaid coverage but too little to qualify for the exchange. These Idahoans are too poor for federal help getting health insurance without your concurrence.

What happens to these citizens, the working poor, if they do not have coverage?

First, their health is poorer and they die more frequently than those with coverage. The magnitude of the excess burden of disease and death is summarized in a recent article from the Harvard Medical School staff (copies were sent to the Committee earlier). I draw your attention to the charts provided to you. The first is national estimates and the second is state by state estimates.

As the charts show, it can be assumed that lack of coverage corresponds to increased rates of untreated depression, deferred health screening (pap and mammogram), decreased use of appropriate diabetes medications and higher rates of catastrophic medical expenditures. But the really striking estimate is of the number of deaths in the population in excess of that expected in insured populations. The authors estimate between 76 and 179 Idahoans in this population will die when they didn’t need to. About 100 deaths each year that are avoidable.

There is also evidence that insured individuals miss less work and have better work performance. If any population cannot afford to miss work it is those below 138% of the FPL.

So what does it cost us to save 100 or so lives each year, and improve the lives and health of these Idaho citizens? The fiscal note explains it fairly clearly. It doesn’t cost state and local taxpayers money, it saves.

The cost of covering this population and removing the state and county liability for the Indigent Fund (including the CAT Fund) has been studied and restudied. Our own Governor impaneled a workgroup, we have both Milliman and Leavitt, healthcare actuarial analysists and financial consultants, and numerous outside organizations pointing out that with the schedule of federal funding (100% for 3 years, 95% for two years and then 90% of the claims expense for this population) when matched against the expected cost to counties through the indigent fund, to the State through the CAT Fund, and to the State Departments of Corrections and Health and Welfare for community services, the savings are in the $500 million range. You should have a chart that shows the difference to the State prepared by the professional actuaries, projecting the difference between coverage and no coverage. While the greatest financial advantage occurs early when the Federal share is 100%, there is no year that the expanded coverage is not a financial advantage to Idaho.

I have heard a couple of concerns about the financials. The first is “what if the Federal Government doesn’t come through, what if they lower the payments”. First of all the ACA includes the payments through 2024, for 10 years. And second,the Supreme Court held that the coverage is optional, we can remove or repeal if there is a better way to meet the needs of those Idahoans at a lower cost.

Another comment was that we need to cut the federal deficit so we should refuse the federal help. Interestingly, I have not heard that with PILT or Craig-Wyden funds, with crop supports, for INL, or almost any other program. In fact we are currently seeking federal funds for clean water primacy, for education networks, and numerous other activities that advantage Idaho citizens. And should we refuse the help, it will not lower the deficit or the taxes on Idahoans. Our Federal taxes will stay the same.

Well, not exactly the same. If we refuse the coverage, the major businesses of Idaho estimate that they will have between $12.5 million and $18.2 million in additional fees and taxes. That is why IACI Supports extending the coverage.

Certainly the medical community and the hospitals do too. Our hospitals, especially our community hospitals, will lose DSH or Disproportionate Share Hospital payments used to help them offset the cost of unpaid care. Without this revenue, the smallest hospitals will have trouble meeting budget. The larger will shift the cost to the commercially insured. The increase in the percentage of their patients having coverage was designed to cover this shortfall. And it will, but only if the coverage is extended.

The list of supporters is very long. They recognize the financial benefit and the health benefit of extending health insurance coverage to working Idahoans too poor for exchange financial support.

But one thing they and most Idaho residents also believe is that we should have a balanced playing field. That things should be fair. I submit that to provide coverage for those in the gap between current Medicaid eligibility and eligibility for the exchange is only fair. It gives them a fairer chance at health, and being able to work and even for life.

Mr Chairman and Committee, the reasons are clear. The bill is too. It merely says that those eligible under Title XIX of the Social Security act and not covered under other programs (Section 1 of bill, Page 3, lines 10-19).are eligible for a plan that conforms to federal rules and meets the restrictions on page 7, lines 7-20. Those features require medical necessity and personal accountability.

Members of the committee, that is why the bill and why now. It is a fiscally responsible and clinically appropriate way to care for those working Idahoans who cannot get coverage and whose expenses fall to the indigent program. It saves lives and saves money. I ask you to introduce the bill and move it forward.

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