John Laufenburger is a year away from the promised land of health insurance: Medicare.
But for now, the almost-64-year-old Boise resident is uninsured. He receives $710 a month from Social Security. That puts him in the Medicaid gap — a group of 78,000 adults in Idaho who can’t afford health insurance but don’t qualify for Medicaid because Idaho has resisted a federal push to get poor adults into the public insurance program.
Laufenburger would qualify for a $30 million program being pitched by Gov. Butch Otter to give low-income Idahoans health care without putting them on Medicaid.
Otter wants to pay safety-net clinics a set amount each month to serve as “medical homes” for Medicaid-gap patients like Laufenburger. Here’s the idea: By having a go-to clinic for primary care, Idaho’s poorest adults won’t rack up thousands of dollars in bills by going to emergency rooms for ear infections. And they would get preventive care.
Would that make a difference for Idahoans? Yes and no.
A PRIMARY CARE STORY
Laufenburger shares an apartment in Downtown Boise with his girlfriend.
His health is about what you might expect for an active 60-something who is under the poverty line. He has depression and anxiety, high blood pressure and a back injury that sometimes hurts so bad, he takes 1,000 milligrams of ibuprofen a day. He wasn’t always uninsured: He was covered through work until 2014, when the back pain caused him to quit a part-time job at Home Depot.
Laufenburger started going to a Family Medicine Residency of Idaho safety-net clinic after hearing about its sliding-scale price from a friend. He loves it. His doctors listen to him. They seek his input. They fit him into their schedules even on short notice. He pays $10 a visit for primary care and psychiatric visits. He pays about $5 for a month of anti-depressant and anti-anxiety medications. He gets blood-pressure drugs from the clinic’s low-cost pharmacy.
“They have been so helpful, it’s unbelievable,” he said.
If Otter’s plan took effect today, the clinic would get $32 a month.
A CRUSH OF PATIENTS?
Family Medicine Residency of Idaho operates six clinics that adults can visit for primary care in Ada County, making it one of the largest providers under Otter’s proposal.
About 3,300 of the 17,000 patients already being seen at those clinics would qualify for Otter’s proposal. An additional 3,000 to 10,000 people who aren’t currently getting care would likely be added to that roster, according to Ted Epperly, a physician who runs the residency program and its clinics.
“Part of the payment for this, too, isn’t to pay for what we’re already doing,” Epperly said. “It’s going to be able to provide the capacity and the access to see those others.”
The clinics would expand their hours into evenings and weekends, and Epperly would hire more doctors, nurses and other providers.
It clearly will lower costs. I’m 100 percent convinced of that. The sad thing, of course, is (the proposal) doesn’t go far enough in regards to ... if the patient needs more care.
Ted Epperly, CEO, Family Medicine Residency of Idaho
Epperly called the proposal a “solid” concept. When patients have access to a primary care team, they tend to be healthier and the overall costs of medical care aren’t as bad. Blood pressure, high cholesterol, mental illness and other common health problems fester and eventually kill many Idahoans every year — or land them in the hospital at great expense. But caught early, they are simple and cheap to treat.
A primary-care pilot project Idaho has undertaken — focused on chronically ill people, not the general population of Otter’s proposal — showed a double-digit decline in hospitalizations, emergency room visits and other costly services, Epperly said.
Under Otter’s proposal, the counties and state would still be on the hook for catastrophic medical bills when people in the primary care program end up in the hospital. Hospitals still would need to write off as “charity care” other bills a patient is unable to pay.
$15 million Cost of catastrophic medical bills paid by state and county taxpayers last year, after Idaho’s poorest were treated for car accidents, general accidents, heart attacks, respiratory illnesses and cancer. These costs and others would not be part of Otter’s plan. They could be lowered through early treatment and prevention.
“Giving these patients access to preventative and routine services through the (primary-care proposal), while helpful, does not necessarily mean that there will be any immediate cost effects — at least initially,” said Saint Alphonsus Health System spokesman Joshua Schlaich in an email. “As time goes on, however, we imagine that those individuals will benefit from accessing preventative services, possibly avoiding future potential health crises. Thus, the potential cost impacts ... are likely minimal at first, but could be beneficial for the health of the community over time.”
Saint Alphonsus is among the providers who would see patients under the new monthly-fee total-cost-of-care proposal, he said.
One big question is whether patients will take full advantage of the program.
Although primary and preventative care services will be offered to the Medicaid gap population, it’s up to them to utilize the benefits in order to avoid potential health crises in the future.
Joshua Schlaich, spokesman, Saint Alphonsus Health System
And it’s unclear whether, in that first year or two, hospitals would see a crush of patients who need free care after finally getting to a doctor and learning their nasty coughs were actually lung cancer.
Epperly is optimistic that over time, costs will settle down as primary care providers screen for chronic illnesses early enough to treat them. But even the best primary care doctor cannot fix everything.
Still, Epperly said, 80 percent of people do not need specialized, hospital care.
Laufenburger is in the other 20 percent.
Laufenburger said he has been fortunate most of his life to take care of others, financially and otherwise. He said he made a good living as a musician in Boise, singing with the Hi-Tops in the 1980s.
But lately, when he can’t seem to find work that isn’t manual labor, he feels more like others are taking care of him. When he fell into alcohol addiction last year, 20 close friends and family members — especially his daughters — chipped in to pay for a month of rehab at Northpoint Recovery near Ustick and Five Mile roads.
A MEDICAL EMERGENCY
But Otter’s plan is just for primary care. No cancer treatment, hospital stays, surgeries or prescription drugs. That means it would not have helped when Laufenburger had a medical emergency while riding his bike near a convenience store last summer.
“I don’t exactly know what happened,” he said. “I was coming out of the parking lot, and something swiped me. ... I’m on the concrete, (and) the next thing I know I’m in an ambulance to St. Luke’s.”
Despite being “pretty scraped and bloody,” with a concussion, Laufenburger soon recovered. But he never found out who hit him.
Laufenburger thinks the hospital may have written off his ER and CAT-scan bills because his daughters were there to vouch for his inability to pay. He has not received any “final notice” statements from the hospital or calls from bill collectors.
It’s thousands of dollars. And what do I do? Pay 10 bucks a month?
John Laufenburger, a low-income uninsured Boisean, on hospital bills from a car crash
So for now, he will continue going to the clinic and doing whatever he can to stay healthy for as long as he can.
Epperly said the plan is not perfect. It can help Idahoans get and stay healthy. Where it falls short is at the crisis point — the health care that’s needed when something goes very wrong.
“It’s a good first step,” Epperly said. “There’s more to it that needs to be done. But at least were having the dialogue in Idaho now. At least we’re talking about it.”