More details emerged Monday on the proposed state-sponsored basic health care plan for low-income Idahoans, as Health and Welfare Director Richard Armstrong gave legislative budget writers his department’s spending overview for the next year.
First, what the program is not: Besides not being health insurance, the $30 million proposal is also “not an entitlement program,” Armstrong told the Joint Finance-Appropriations Committee. Enrollment is subject to available funding, he said. Also, participants pay a share of costs and must be “actively engaged in their treatment plans. If not, they lose eligibility,” he said.
An estimated 78,000 adults could enroll — representing the population that currently doesn’t qualify for Medicaid or for subsidized health insurance on the state health exchange, created under the federal Affordable Care Act. The proposed program would subsidize doctor visits and other basic care but would not pay for emergency room visits or hospitalization.
The department based its $30 million cost projections on a target enrollment of 75,000. That cost, paid with cigarette and tobacco taxes, is based on $32 per month to primary care facilities for each participant. Those enrolled would pay a sliding-scale portion of the cost.
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Armstrong said the patient portion could range from $3 to $25, depending on income. The program would start Jan. 1, 2017, with enrollment coinciding with annual insurance enrollments via the state exchange.
In response to questions from lawmakers:
▪ Armstrong said costs would be contained by the availability of funds. Among potential factors, income from cigarette taxes is declining by approximately $1.4 million a year and demand could outstrip funding.
“So this has to be managed very closely,” Armstrong said. “If we find ourselves in a squeeze and we just don’t have enough money and we have more people who want to participate than we have money, we have one choice: to create a waiting list.”
▪ Asked how the state could estimate the potential return on investment, Armstrong said it was difficult to measure potential savings based on “what didn’t happen” or to predict “how many people are going to come in and what their conditions are.”
The committee, which reviews the governor’s budget and sets spending, will hear more details on the proposal Wednesday.