This legislative session’s three-month debate over what Idaho can and should do to help the state’s working poor get better health care comes down to one hearing this week, and one bill whose passage out of committee appears safely in hand.
If, over the next few days, the bill also makes it through the House and Senate, Idaho will turn a corner in a three-year debate over a follow-up provision of the 2010 Affordable Care Act, which to date has helped 20 million Americans get health insurance.
Will it pass the Legislature? Its supporters think they have the votes. How did we get here? What does the bill under consideration do? Let’s start with the first question.
PCAP, THE STATE’S SACRIFICIAL PLAN
Expanding Medicaid to cover Americans whose incomes didn’t qualify them for subsidized health insurance under the ACA was a significant component of what’s come to be known as Obamacare. Partisan opposition has impeded state-by-state implementation, although more states have opted in through the use of waivers that allay Republican objections. Nineteen states have been hold-outs, Idaho among them.
Last fall, the state Department of Health and Welfare put together a state-sponsored, state-funded proposal for the 78,000 Idahoans in the gap group. The plan wasn’t insurance, just a subsidy to help that population get to the doctor and avoid much more serious and costly urgent care. But the economics just didn’t make sense, and it died in committee.
That bill died so others could live. Its sacrifice spurred a financial reconsideration of the Idaho health system for the poor, which is covered by inefficient, expensive state and county indigent programs. As it turns out, those costs have dropped significantly in recent years because more Idahoans have insurance. The economic argument bolstered the humanitarian case, already embraced by many lawmakers, for helping the gap group.
HOW WOULD THAT HEALTH CARE BE DELIVERED?
Republicans remain opposed to plain-vanilla Medicaid expansion, wanting more accountability and control over how federal money would be spent. Other states got waivers from the federal government to permit this. As events have unfolded, Idaho had the perfect vehicle for delivery.
Even as opposition to expanding health care subsidies persisted, Idaho in 2014 received a $40 million innovation grant from the federal government to begin remaking the system, moving to community-based primary care facilities and away from fee-for-service that drives up costs. The program is cutting costs and improving patient outcomes.
WHAT THE ‘IDAHO ACCOUNTABLE CARE WAIVER ACT’ DOES
The bill coming to House Health & Welfare authorizes the Department of Health & Welfare to seek a federal waiver for the type of program Idaho wants. Essentially, the state will seek a block grant to pay for a managed-care program for the gap group, using the pioneering community-based care programs that emphasize primary and preventive care.
Eight lawmakers, three Republicans and one Democrat from each house, would review public monthly reports on where the waiver application stands. The state would award a grant later this year to help collect data that supports the application. If the federal government does approve the waiver, the Legislature would still get another chance to sign off before it moves forward.
If the federal government rejects Idaho’s waiver application, that’s it. If the feds approve it, the state will begin eliminating the county and state funds catastrophic care funds. The first enrollments could start next year.
BUT WILL IT PASS?
The new bill was still being finalized Friday and might see revisions over the weekend. When it was first mentioned in committee Thursday, all 11 members spoke of their commitment, some movingly, to helping the gap group. Chairman Fred Wood, R-Burley, said the committee’s next agenda would be telling: More than one bill would be a signal that agreement hasn’t been reached. So far, there’s only one bill scheduled for a hearing. Rep. Lynn Luker, a Boise Republican, is presenting it. It will pass.
That’s not set in stone. Just a few days are left in the session. The House might take it up on Tuesday, the Senate thereafter. Does it have the votes? The bill would need support from 22 House Republicans, assuming all 14 Democrats approve; it would need at least 11 Republicans in the Senate, with the seven Senate Democrats. Supporters aren’t claiming victory yet, but the wind is definitely at their back.