Julia Robinson: Idaho could learn lessons from Oscar movies

January 26, 2014 

Two Academy Award nominees for best picture this year spotlight the United States’ HIV/AIDS policy in the 1980s. “The Dallas Buyers Club,” set in 1985, focuses on one man’s fight to access AIDS treatment. In this raw, wrenching movie, government is the enemy, a stagnant, nonresponsive bureaucracy that allows people to die. In “Philomena,” HIV/AIDS is tangential to the poignant story of a woman’s search for her son over a 50-year period. One snippet showcases the Reagan White House in the early ’80s, when gay men remained in the closet and HIV domestic policy was silence. The pain of these stories for public health workers is particularly intense because in the 1980s, public policymakers knew how to help. The HIV pandemic was not a result of lack of knowledge but a failure of government to act.

By 1985, HIV incidence had risen to an alarming 130,000 new individuals annually in the U.S. These individuals had a life expectancy of less than a year. When the deaths continued to climb, as did the number of reported infections, U.S. public policies began changing from inaction to prevention. From the start of HIV/AIDS federal funding, incidents and deaths began to decline. The Kaiser Family Foundation reports that today about 1.1 million Americans are living with HIV. Another 50,000 become infected annually. In other words, there is more to do, but as a country we are aware of the issue and working on addressing it.

You may ask what does the history of HIV/AIDS have to do with Idaho? Today, Idaho stands at a public health crossroads. The key public health issue of our time is whether or not to take Medicaid expansion funding. The statistics to accept this funding are compelling. It will provide insurance to 104,000 Idahoans. Over 10 years, this program will save taxpayers over $479 million.

With expansion, we could implement a positive health prevention program rather than continue Idaho’s antiquated county indigent and catastrophic programs, whose costs jumped 10.6 percent last year alone. These programs fund health care for low-income individuals that focuses on acute care in the emergency room, the least effective and most expensive type of care. Medicaid insurance affords Idahoans the opportunity to choose health by allowing prevention screening and early intervention for diseases, and providing appropriate management for chronic conditions such as diabetes and heart disease, and ongoing mental health care.

Our governor has chosen to delay Medicaid expansion for a second year. He has asked that Medicaid be fixed before taking action toward reform. Other states have taken a different tack, aggressively changing Medicaid while implementing expansion. For example, in Arkansas, healthy low-income individuals are allowed to use Medicaid funds to purchase insurance on the state exchange. Very preliminary results suggest this approach has brought younger adults into the exchange risk pool. The younger demographic has the potential of reducing everyone’s premium longer term. This is just one example of states choosing to expand and innovate in tandem.

I understand the governor’s desire to avoid a divisive legislative battle with hotly contested Republican primaries. This year a vote for health care might mean a vote out of office. For the public, however, immediate action will save public funds and keep people alive.

John Maxwell, an author on leadership, writes, “The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” We’ve done enough complaining about Idaho’s health care programs; let’s work together to adjust the sails.

Dr. Julia Robinson is director of community affairs for a local community health center and has more than 30 years of executive management experience in health and human service agencies.

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