Idaho lawmakers convene for initial review of health options for poor | Idaho Statesman

Lawmakers exploring health care alternatives for poor Idahoans convened Tuesday at a hearing where off-topic detours underscored lingering ideological differences that have blocked consensus on a resolution.

“I think that this whole thing comes down to what’s becoming very accepted in our culture today, and that is not accepting responsibility for yourself,” said Sen. Patti Anne Lodge, R-Huston.

The issue is how to improve health care for 78,000 Idahoans who, despite their low incomes, earn too much to be eligible for Medicaid but not enough to qualify for subsidized health coverage available via the exchange that Idaho created under the 2010 Affordable Care Act.

The ACA included a provision to expand Medicaid to cover such gap populations. But the 2012 Supreme Court ruling that upheld the health law also made expansion optional for states. So far Idaho remains one of 19 states that have declined expansion.

Among the rest, several have sought and received federal waivers to implement customized programs that give them greater control over how federal Medicaid dollars are spent.

Idaho health officials and Gov. Butch Otter’s administration support such an approach, and two governor-appointed commissions have endorsed it, to no avail. Besides providing better health care, accepting the federal dollars would eliminate costly, inefficient state and county programs that now cover catastrophic and indigent care for the poor.

The administration has declined to move on such a plan without official legislative buy-in, and to date the Legislature has balked.

This past session, Otter’s health department floated a modest, state-funded alternative to move away from the current system. But the proposal, dubbed the Primary Care Access Plan, did little to address costs or substantially improve health care and went nowhere with lawmakers.

A bill authorizing state officials to pursue the customized, federally approved expansion plan gained steam late in the term but ultimately died in the session’s final hour.

The panel reviewed all of that history Tuesday. Asked why the access plan failed, Health and Welfare Director Richard Armstrong told panel members that it was quickly seen as ineffective for both improving care or restraining costs.

“A lot of the supporters that we had had for Medicaid expansion looked at PCAP and said, ‘You know, that’s like kissing your sister. This is not good,’ ” Armstrong said to muffled laughter. “It lacked the solutions of the underlying costs that everybody’s bearing.”

Lawmakers set their next meeting for Aug. 11 and said they wanted to work quickly on a subject that has been long studied.

“I don’t want to see this effort become data rich and policy poor,” said Sen. Jim Guthrie, R-Inkom.