Idaho’s health care gap: It’s time to act

Dr. Ted Epperly speaks before the Idaho Senate Health/Welfare Committee during an information hearing on Medicaid expansion that attracted a mass of people eager to comment on SB1205 Tuesday, Feb. 2, 2016, at the Statehouse in Boise.
Dr. Ted Epperly speaks before the Idaho Senate Health/Welfare Committee during an information hearing on Medicaid expansion that attracted a mass of people eager to comment on SB1205 Tuesday, Feb. 2, 2016, at the Statehouse in Boise. doswald@idahostatesman.com

A gap is a space between two people or things, a hole where something is missing. A gap is a separation in space, an incomplete or deficient area. A gap is a lack of balance, a disparity, a wide difference in character or attitude, a break in continuity.

In Idaho health care, a gap is a shameful, negligent and painful number: 78,000 uninsured citizens — that’s enough people to occupy the combined populations of Eagle and Pocatello. That 78,000 represents fellow citizens too poor to access health care subsidies through the Your Health Idaho Exchange, but who make too much to qualify for Medicaid coverage. The Statesman has been chronicling their plight: They are mostly working poor, many with annual income ranges between $11,000 and roughly $16,000 — that second number is in line with a person making the $7.25 hourly minimum wage who works 40 hours per week.

We know the Gap People are adults (children are covered by Medicaid), most of them 18 to 55 years old, the majority of them women. We know the Gap People do not get or seek medical care as often as the rest of us do — until some condition spikes and they find themselves in an emergency room or facing critical care that will cost the system (and ultimately taxpayers) a lot more than if they had a relationship with a primary care facility.

And we know they are hurting, and mired in a hole of helplessness from which they must be rescued.

We and concerned stakeholders all over Idaho are up to our eyeballs with data and studies and empathy-without-action that has netted nothing for the Gap People to date. We watched last April when the Legislature essentially abandoned the uncovered Idahoans for another season when lawmakers walked away from the 2016 session without acting. We watched the idea of a May 2016 meeting for an interim committee to tackle the issue languish for two months before this group finally gathered in late July, and then again on Thursday.

“If we don’t cover people, we know that there are people out there who will live sicker and truly die younger,” said Dr. Ted Epperly, President and CEO of Family Medicine Residency of Idaho, who testified this week before the Idaho Legislature’s Healthcare Alternatives committee, a bipartisan, bicameral interim study group.

The official name of the committee — The Healthcare Alternatives For Citizens Below 100 Percent of Poverty Level — is a body of 10 representatives and senators tasked with coming up with a policy to care for the Gap People.

We’ve attended (in person or via live streaming broadcasts) both of the committee’s meetings so far, and will attend the next scheduled meeting when it reconvenes 9 a.m. Monday, Aug. 29.

Though we’ve been impressed with the group’s diligence and scope of investigation so far to consider what Co-Chairman Rep. Tom Loertscher, R-Iona, calls a “puzzle” — we as an Editorial Board are committed to monitoring and impacting the outcome until it is solved.

Beginning today, we’re publishing a weekly series of editorials titled Filling the Gap. Next week we will present “The Financial Argument” for addressing the Gap People because, to date, Idaho — by virtue of resisting Medicaid expansion — has bypassed a potential infusion of hundreds of millions of federal dollars that experts say could have produced $2 billion in economic impact while providing coverage and better health for those 78,000 people.

Our schedule for other editorials — “The Moral Argument” to cover our neighbors, and sharing what we’ve learned about “Who Lives in the Gap” — will depend somewhat on the agenda and progress of the Healthcare Alternatives committee. So, stay tuned.

There are volumes of studies from previous task force work that have never been acted upon. Though some legislation got written in 2016, it was rejected by the House — curiously just weeks before the May Primary.

All the while our Idaho gap continues to swallow up our neighbors while some lawmakers (we pay all of their health insurance costs, by the way) study and posture and fret about their anti-federal resumes as they approach a November election.

Despite that past track record, we see flickers of hope, and we know this body is capable. Lawmakers took the advice from Gov. Butch Otter’s Your Health Idaho Task Force in 2013 and later passed legislation to institute one of the most successful state-run health-care exchanges anywhere when faced with the Affordable Care Act mandates passed by Congress in 2010.

“The irony of it is that the very people who did everything that they could to keep the insurance exchange from ever happening — the ultra conservative side of the Legislature — were really happy to get the reversion into the general fund so they could spend it on their other stuff,” said Dick Armstrong, director of the Idaho Department of Health and Welfare. Armstrong is a champion for the cause of getting coverage for the Gap People. “We reverted $28 million that didn’t need to go into the CAT fund (Catastrophic Health Care money set aside to pay for the expenses of the uninsured under the present system).”

This committee’s work and policy recommendations to cover the Gap People then must be put into legislation and implemented — or we still will be spinning our wheels and leaving those 78,000 in the gap ditch to fend for themselves.

We know from our conversations with committee members that offering a blanket “No” again is unacceptable — and we know they have made such vows before. What we don’t know is whether the Legislature will be satisfied with just a “next step” approach or whether it will have the political will to truly engage with the federal government to bring the most coverage through full-on Medicaid expansion, or pursue a customized Idaho solution by using federal money in a “waiver” acceptable to legislators and green-lighted by the gatekeepers: the Center for Medicare & Medicaid Services.

Sen. Jim Guthrie, R-Inkom, said it best at the conclusion of the Healthcare Alternative committee’s first meeting. Referencing his colleagues, he said the discussions can’t be “data rich and policy poor.”

It is time to act. Time to fill the gap.

Statesman editorials are the unsigned opinion expressing the consensus of the Statesman’s editorial board. To comment on an editorial or suggest a topic, email editorial@ idahostatesman.com.

Background and coverage about how 78,000 Idahoans ended up in the gap

Congress passed the Patient Protection and Affordable Care Act in 2010 and its mandates really came on to the radar of the 50 states beginning in 2012.

▪  A mandate to offer health insurance coverage — via a state-run exchange or by using a federal template — was debated in Idaho, but the Gem State ultimately decided to create its own exchange. Your Health Idaho came online in 2014.

▪  When the U.S. Supreme Court ruled to uphold the constitutionality of the ACA in 2012, it also left open the option for states to decide how they would cover citizens who did not qualify for insurance through Medicaid — as well as those who could not afford to purchase coverage through one of the exchanges. It was assumed when the ACA was drafted that all the states would expand Medicaid to cover those “in the gap” because 100 percent federal reimbursement initially was offered to the states (diminishing and leveling off at 90 percent). More than 30 states have expanded Medicaid. Idaho has not.

▪  For several years Idaho has studied whether to expand Medicaid, do nothing and keep paying expenses out of its Catastrophic Health Care CAT fund, or create some kind of hybrid using state funds, federal funds or even some combination. That’s where we are as a state today while the 78,000 are still in the gap.

Click here to find links to information about Idaho’s journey through this process, studies the state has commissioned, the ongoing work of the Healthcare Alternatives For Citizens Below 100 Percent Of Poverty Level committee, the Idaho Statesman’s own news coverage and some of the Guest Opinions that have appeared in the Opinions section just this calendar year.

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