Gov. Butch Otter’s Idaho health care plan in jeopardy; what happened and what’s next?

A house committee Monday voted against introducing a funding bill for the proposed Primary Care Access Plan, or PCAP. The program by Gov. Butch Otter’s administration, is a state-funded alternative to Medicaid expansion that would subsidize doctor visits for Idahoans who lack health insurance. After the committee’s vote, the leading House sponsor said the PCAP plan is likely dead.

What was the vote on Monday?

The PCAP plan needs an approved source of funding as well as approval as a matter of policy. The bill before the House State Affairs committee Monday was a proposal to partially fund PCAP using some of the $25 million Idaho receives annually from the 1998 multistate settlement with tobacco companies over tobacco-related health care costs. With little discussion, the committee voted 8-6 against introducing the bill for a full hearing.

Why did the committee vote no?

At least four reasons, involving both money and policy. Some Republicans on the committee and in the Legislature as a whole oppose PCAP in general on the ground that it is a new entitlement program. Democrats, including two on the committee, oppose PCAP because they see it as an expensive and inadequate alternative to expanding Medicaid. Expansion would provide a route to health insurance for 78,000 Idahoans who currently can’t get coverage and would bring with it a windfall of federal cash.

Opponents also objected to using tobacco settlement money for PCAP, as well as to a “piecemeal” approach to identifying a funding source.

So it was just about the money?

Although the bill dealt only with a portion of PCAP funding, its failure to win a full hearing on its merits was seen as a lack of support for the entire program.

Weren’t cigarette taxes supposed to pay for PCAP?

As first outlined last fall, PCAP was to be funded by an increase in cigarette and tobacco taxes. When that plan found no favor with lawmakers, the administration revised its proposal to use existing cigarette and tobacco taxes. That plan hasn’t won over lawmakers.

Is there any other money?

In January, the state identified $29 million in savings from the state Catastrophic Health Care program, which, along with county programs, pays health care for indigent people. CAT fund expenses have declined as more people have obtained health insurance under the Affordable Care Act and the state health care exchange.

Those CAT fund savings could help pay for PCAP, but they are a one-time-only windfall. Future CAT costs are unpredictable and could even got up if more people go to the doctor under the PCAP incentives and find out they need treatment that isn’t covered — which is essentially everything except a basic exam.

What happens now? Is the PCAP proposal dead?

Technically no, but practically speaking, probably. Lead sponsor Rep. Fred Wood, chairman of the House Health & Welfare Committee, thinks so. It could be resurrected in State Affairs if the funding question is resolved. As one lawmaker said Monday, it’s accurate to say the legislation is in the critical care unit. Nothing more will happen unless the money issues are worked out.

What did Otter say?

Spokesman Jon Hanian said the Governor’s Office had no immediate comment.

What else is out there?

Earlier this month, the Senate Health & Welfare committee heard testimony on a bull to accept federal aid for a full Medicaid expansion, but took no action on it. Technically, the committee could still vote on the bill, but as Wood observed Monday: “Everybody wonders why we don’t do Medicaid expansion. Well, there’s no support for Medicaid expansion, and there doesn’t seem to be much support at all for the PCAP program.”

This story was originally published February 15, 2016 at 11:28 PM with the headline "Gov. Butch Otter’s Idaho health care plan in jeopardy; what happened and what’s next?."