To address the coverage gap for 78,000 Idahoans, the Idaho Freedom Foundation suggests that charity care, built upon a model of 1915 fraternal organizations, would be more than adequate. In 1915, if you had a serious illness, you died. Mortality during childbirth was high. Life expectancy was lower. In part because fraternal organizations provided a fraction of a solution, hospitals and doctors created Blue Cross and Blue Shield.
A basic premise of the IFF is that government should not fund health care. That position would end Medicare, the Children’s Health Insurance Program, Medicaid for persons with serious disabilities and for pregnant women, and tax credits through Your Health Idaho. Those results would be disastrous and cause most of Idaho’s rural hospitals to disappear.
There is an important and ongoing role for charity in health care. It occurs every day with health care providers. Could more be done? Sure. Would it be sufficient? Absolutely not.
The uninsured live throughout Idaho. Any solution needs to reach all, not just those in urban areas. Assuming that only 20,000 have a chronic illness, and using the Milliman study of cost to cover them, the annual cost would be $88,800,000. Idahoans are very generous, but to expect that we could come up with that much money each year of new charitable donations is a real stretch. Even if medical providers donated more freely of their services, that goal is unreachable without taking funding from other charities.
A charity care approach would require the voluntary participation of multiple medical providers. Since it’s voluntary, if any one provider chooses to limit or not participate, the structure begins to crumble. Some entity, not paid now, would have to coordinate this massive effort.
IFF is proposing that individual taxpayers could donate their grocery tax credit and/or their income tax refund to help low-income individuals. We can donate now. It proposes to redirect Millenium Funds and county and state catastrophic funds. Those are already dedicated to health programs. It proposes that local charities raise local matching funds. Again, this creates more strain on the charitable giving of Idahoans. Working in the nonprofit field, I know the inherent difficulties in the IFF proposal. Most nonprofits don’t have the infrastructure, the funding or the expertise to do what IFF proposes.
IFF presents some models of charity care at work. They all have value. They all are much smaller in scope than what is needed for a statewide effort. They struggle for funding and volunteers. They operate in a few urban areas.
So, while there is value in exploring these ideas, they are at best a partial potential solution and at worst a dangerous distraction. They would still leave many without coverage. Adoption of the Idaho Freedom Foundation proposal is not a real solution. It does not, and cannot, offer full coverage of essential services. Living below the poverty level and without health insurance means you will live sicker and die younger. Our neighbors deserve better.
Stephen Weeg was a member of the Governor’s Medicaid Redesign Work Group. He is the board chair for Your Health Idaho and also a board member of the Portneuf Health Trust, Portneuf Medical Center and the Department of Health and Welfare.