Butch Otter on Medicaid expansion, health care


March 29, 2014 

Butch Otter

It's been my goal as governor to make health care more affordable and accessible for all Idahoans. We are making progress, bringing the health care community together as never before and working to make our system more about patient outcomes than doctor visits.

And we aren't going to let Obamacare stop us from pursuing meaningful improvements for Idaho.

The strategy behind the ironically named "Affordable Care Act" involves the government requiring everyone to have health insurance, one way or another. Expanding Medicaid to far more people is a linchpin of that strategy, aimed at co-opting states like Idaho into helping meet the heavy-handed federal mandate. But the U.S. Supreme Court wisely gave us a choice in the matter. As governor, I choose to look for alternatives to growing an entitlement program that's in serious need of reform.

With health care costs continuing to consume more of our economic output, simply adding more people to a one-size-fits-all government-controlled system is not the answer for us. All that kind of manipulation does is skew market signals and take health care decisions out of the hands of patients and doctors. It does nothing to reduce costs.

Every group of Idaho experts I've assembled over the past seven years has recommended better care coordination and case management as keys to improving outcomes and reducing costs - especially for patients with chronic diseases. That's why my administration is using that "medical home" primary care model as the basis for developing and implementing a Statewide Healthcare Innovation Plan (SHIP) with a greater focus on preventing illness and encouraging healthier lifestyle choices.

It's not the whole solution, but it is the kind of market-driven reform that works for Idaho. It involves keeping pace with evolving improvements in health care delivery and incorporating best practices being used successfully and efficiently elsewhere. It also involves working with Idaho primary care physicians to adopt a more a patient-centered approach that empowers rather than entitles.

Most Idahoans are able to get health care coverage privately through an employer or through our Idaho-based insurance exchange. Medicaid benefits in Idaho now go only to our most vulnerable citizens - primarily children and the disabled. So expanding those taxpayer-funded benefits as the Obamacare strategy envisions means covering low-income but able-bodied adults.

Even if you accept the idea that expanding Medicaid to that population will mean spending less overall for acute, emergency and indigent care; even if you believe that the fiscally irresponsible federal government will keep picking up the tab for that expansion and not leave Idaho taxpayers on the hook for meeting raised expectations; and even if you think the government insuring more people is simply the right thing to do, the fact is most independent and self-reliant Idahoans want a better solution.

That's why my administration is so carefully evaluating other states' plans for covering people in the gap between subsidized private coverage and today's Medicaid eligibility standards. Providing more access without making the Medicaid system more accountable for how taxpayer dollars are used will not make health care more affordable. It will just strangle us a little more slowly.

We have not yet found the right way to address the difficult realities for Idaho's remaining uninsured under Obamacare. But our search for ideas and innovations continues, and my commitment to making health care more accessible and affordable for Idaho is stronger than ever.

Otter, in his second term as governor, lives in Star.

Idaho Statesman is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service