Guest Opinions

Idaho Medicaid expansion debate framed by tragedy and public policy

At the Senate Health and Welfare hearing to consider the Medicaid expansion bills, one doctor from Eastern Idaho who had cared for a patient who died from severe asthma laid that death at the feet of the Idaho Legislature. In fact he suggested the legislature is “killing” hundreds of Idaho citizens. I thought I would look into that accusation.

We do know delay has cost dollars. By not acting in 2013 when we first could have, Idaho has lost hundreds of millions. But savings not received are like rain that didn’t fall; it’s hard to measure.

We do know that a positive decision by our Legislature and governor did result in savings for the taxpayer. The Catastrophic Health Care Fund Board, (CAT Fund), of which I am a member, returned to the state general fund this session almost $30 million almost all due to folks getting insurance through the state health insurance exchange.

So were lives lost that we can pin on us legislators? Jenny Steinke’s story is compelling. Her death reminded me of another from years ago. I treated a young man with severe asthma who would never come in because he had no insurance or money. He struggled, always on the edge of a severe attack. I hospitalized him a couple times and saw him in the office whenever he came in, giving him as much free medicine as I could gather. He hated the disease, the disability, but worse, his mounting debt. But then I signed his death certificate when he was found dead at home at the age of 30. If he’d had insurance would he be alive now? Was this death inevitable? The death averted by appropriate care is much like that rain that doesn’t fall; hard to know, hard to count. But it was always my goal as a physician.

Now I make public policy. And it is still an honorable goal.

Every couple of months we get applications from counties to the CAT Fund. There end up being about 1,200 a year. We got a smaller batch in December, only about 120, since the case numbers are trending down thanks to the Your Health Idaho exchange. I went through those cases this morning to look for deaths or diseases that might have been prevented. It’s very hard to tell from the sketchy details provided. Here’s my list from just a tenth of the annual cases:

▪ 64-year-old male, income $800/mo; skin infection: tissue infection: DEATH taxpayer cost: $145K

▪ 42-year-old male, income $1200/mo; multi-organ failure: SURVIVED taxpayer cost: $36K

▪ 51-year-old male, income $200/mo; UTI; sepsis; DEATH taxpayer cost: $46K

▪ 32-year-old male, income $00/mo; tooth infection; neck infection; SURVIVED cost: $22K

▪ 56-year-old male, income $730/mo; heart disease: infection; DEATH cost:$165K

▪ 38-year-old male, income $2300/mo; Stroke; DEATH cost: $138K

▪ 56-year-old female, income $00/mo; GI bleed; DEATH cost $30K

▪ 62-year-old male, income $500/mo; pneumonia:cancer; DEATH cost $15K

Honestly, I really don’t know if all of these deaths could have been averted, I doubt anybody does. I did my best to communicate to the young man so long ago I would happily see him for no charge. I wanted him healthy and productive. But his disease, like Jenny Steinke’s, proved fatal.

There are so many reasons why our current indigent and catastrophic system is wrong. I will let you decide if it is killing people. But I can see a way out of this drought. And we are in one, can’t you see?

Dan Schmidt, a Democrat, is an Idaho state senator who lives in Moscow and represents District 5. Among his assignments is the Health and Welfare Committee.

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