We struggle as much as our lawmakers when considering how to attain affordable health care for all Idahoans — particularly the 78,000 left in the gap who make too much money to be considered for Medicaid and too little to access subsidized coverage through the Your Health Idaho exchange.
But there is no need to struggle. Our leaders could take action to accept Medicaid expansion, as 31 other states (even conservative Republican ones) and the District of Columbia have done. These states have decided to tap federal funding under the Affordable Care Act and access an unprecedented level of health care for some of their most vulnerable citizens.
There is resistance in Idaho to accept a new “entitlement” program that, yes, the federal government would subsidize now — but what about the future? What happens if down the road the federal government decides it can no longer fund the program?
This what-if scenario is real — but no more real than the critical need to get health care for Idahoans.
Gov. Butch Otter and the Legislature are studying alternative methods to get some measure of health care to our “gap” citizens. Although the Primary Care Access Program now being considered would establish relationships with a doctor and would cover preventive care, “it would not cover acute or chronic care, hospitalization or prescriptions,” as the Statesman’s Bill Dentzer reported this week.
Money for PCAP would come from state tobacco and cigarette taxes and thus avoid any federal source. But such funding comes with risks, just as federal funding does. And though it is true that PCAP gets “gap” Idahoans to first base, it leaves them there. What would be the options for someone diagnosed with cancer or diabetes who needed treatments? The level and extent of care at first base would be different and uneven, depending upon what clinic one accessed throughout the state.
We also don’t feel comfortable calling this an “Idaho solution,” though its proponents do. At best it is a first step that will never go the distance and serve all Idahoans in a way Medicaid expansion could.
Two Otter task forces concluded that some form of Medicaid expansion was the preferred path in Idaho. The last recommendation in 2014 estimated savings of $173 million over the next 10 years.
We’ve heard all about the lack of political will to get it done. Lawmakers have found the sweet spot of political will to get behind education to the point where keeping up with spending increase plans is now a foregone conclusion. We congratulate Otter and the Legislature for finally getting this done. It happened because the stakeholders involved would not take “no” for answer.
Idahoans should not take “no” for an answer on Medicaid expansion, either, and should not accept PCAP alone unless it can lead to something more comprehensive.
Otter expended great political capital and took great risk when he agreed to go with an insurance exchange in Idaho in 2012. OK, accepting Medicaid expansion right after that would have been a stretch. But campaigning for Medicaid expansion is within reach now for a governor who won’t be running again and who shouldn’t be worried about hoarding his political capital.
Accepting Medicaid expansion does not have to be forever. Idaho could use it as an interim plan and walk away at any time — as soon as it finds a true Idaho solution that doesn’t leave people stranded at first base.
The feds seem eager to hand out waivers that allow flexibility about how to manage the federal money meant for those in need of health care. Accepting Medicaid expansion on an interim basis would make sense; if not, let’s get things rolling with PCAP. But then let’s fashion a true and lasting Idaho solution that rescues our friends and neighbors from the gap.
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