Guest Opinion: Legislators need to step up and give Idahoans coverage

January 10, 2014 

There is a new Gap in Idaho, but I’m not talking about a store. Whether you like it or not, the Affordable Care Act is the law, and fighting that fact doesn’t serve Idaho. Clearing up misconceptions, however, could bring relief to many, greater cost savings for Idaho, and a safer society as a whole.

ACA was designed for three tiers of citizen coverage: 1) Citizens/companies would choose and pay for health care coverage; 2) Citizens with less financial resources but above poverty level would choose coverage and receive assistance to pay for it; and 3) Citizens below poverty levels would be covered through an expanded and redesigned Medicaid program. In this way all citizens would be covered. Note that the Medicare program is not a part of any of this, being entirely separate.

This was the plan. Enter the U.S. Supreme Court, which ruled that the ACA could not require that states expand Medicaid. For the poor in Idaho, this ruling unfortunately brought a new way for politicians to “vote” against Obamacare. The result? A Coverage Gap for Idahoans who don’t earn enough for assistance, but earn too much to qualify for Medicaid.

Of those in this category, about 80 percent are self-employed workers, minimum wage workers or employees in small businesses. For example, a family of four who has an income of less than $32,500 a year would not have medical coverage. Likewise for an individual who earns less than $11,490 annually.

To be fair, Gov. Otter did his due diligence and appointed a balanced nonpartisan task force to study the Medicaid options. They unanimously suggested to expand and redesign Medicaid with federal assistance. But, against his experts’ opinions, the governor said “not now,” and Idaho lawmakers followed suit.

Is this because we have an adequate system already? No. Currently Idaho has a state and county indigent program to assist citizens facing catastrophic medical debt, but not regular medical care coverage or preventive care. The indigent program costs the state and county taxpayers more than $60 million to aid only 6,000 individuals statewide, with many going without any assistance.

Is it because it would cost too much to implement? No, in fact it would save money. The additional costs of an expanded Medicaid will be covered 100 percent by federal aid for the first three years of ACA, after which the state will pay 10 percent. (However, Idaho has lost one year of that assistance, so far.) Since the present indigent program will be eliminated, the state will actually save money and provide more people with comprehensive health. Financially, what isn’t there to love” It appears to be a win-win situation that both the task force and major business groups endorse.

Politically, however, it remains to be seen whether our lawmakers can accept this part of Obamacare and design an expanded Medicaid program. Only then will all Idahoans have health care coverage.

One last comment. In the coverage gap are those who have mental challenges but aren’t considered disabled. A year after Sandy Hook, suggested mental health care solutions have fallen through the cracks. With the redesigning of who can be covered by Medicaid, it is estimated that nearly all Adult Mental Health Service citizens could be covered. Besides again saving money, providing for early mental health intervention and ensuring ongoing treatment and support makes for safer communities. Since 21 percent of uninsured Idahoans live with a mental illness, can we really afford to ignore those in the Medicaid Gap who need consistent mental health care?

C’mon, legislators, let’s close the coverage gap.

Jan Neish, of Pocatello, writes for Island Park News.

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