Printed on: April 01, 2013

Lewiston Tribune: Idaho's legislators are busy; take a number


Notable examples of jobs left incomplete:

The telephone carrier that offers only incoming calls.

You must be logged in with the proper services to print this article. The electrical utility that provides service only on weekdays.

The fire department that calls it a day at 6 p.m.

The 911 dispatcher who asks you to leave a message while he takes a lunch break.

The 2013 Idaho Legislature.

Idaho's 105 lawmakers are so fixated on closing down their session they'll leave unfinished the most important piece of business on their plate. Millions of tax dollars will go wasted and hundreds of Idahoans could die in the process.

At issue is Idaho's opportunity to extend Medicaid coverage to impoverished adults. Obamacare gives Idaho that option beginning Jan. 1.

No state has a better reason to take this deal. Between its county medically indigent program and the state catastrophic health care fund, taxpayers cover the medical costs of those deemed unable to pay. Now running about $55 million, this open-ended entitlement could reach $77 million in another year if caseload growth and inflation are factored in.

For the first three years, Obamacare would pick up 100 percent of the cost of providing Medicaid to the same population. Thereafter, the state's share would never exceed 10 percent.

During the next decade, converting to Medicaid would save Idaho taxpayers $478.6 million.

So what's the hang-up?

For starters, there's Gov. C.L. (Butch) Otter.

Where many of his colleagues - including Arizona's Jan Brewer - have been assertive, Otter has been passive. He wants to wait a year to produce some reforms - even though those reforms could be enacted after Medicaid is expanded.

That was a weak ploy when Otter first made it in January. It's even more pathetic now.

Relying on federal estimates, the state expects 104,211 adults to qualify for this coverage - up nearly 30 percent from earlier estimates. That means the dividend of acting now - or the price of timidity - has jumped to $40.5 million for the new budget cycle that begins July 1.

Does anybody think Idaho has $40.5 million to play with?

Six years after the Great Recession struck, Idaho's budget has yet to recover. The amount of state support for school operating costs remains below its pre-recession levels, which explains the explosion in local supplemental property tax levies. Higher education is still behind. Health care for the truly vulnerable, already inadequate, has not been restored.

Yet lawmakers indulged their ideological fetish by spreading $35 million in tax breaks for the well-off last year and are about to pass along another $20 million in business tax cuts this year.

Why not pay for this latest tax reduction by making government health care more efficient - and more effective? Idaho's medically indigent/CAT Fund pays for health care often delivered in a crisis. For tens of thousands of low-income Idaho adults, Medicaid would offer ongoing, preventive care. It's something as simple as getting treatment for diabetes today rather than waiting for a heart attack tomorrow.

Says the New England Journal of Medicine: For every 176 people brought under Medicaid coverage, you save a life. Bring 104,211 Idaho adults into Medicaid, you save 593 lives.

Plus, you add 6,000 jobs and $277 million to Idaho's gross state product.

The case has become so compelling that Otter's Medicaid work group last week practically begged him to get off the fence. With that, the panel handed him unanimous support for the Healthy Idaho Plan, a Medicaid reform package that includes personal accountability and cost containment strategies.

Idaho's lawmakers are not deaf to these facts. You will find no more conservative member of the Legislature than state Rep. Tom Loertscher, R-Iona.

Loertscher is making the case for expanding Medicaid coverage and closing down the indigent/CAT programs.

Getting lawmakers, already worn down by the battle to pass Otter's state-based health insurance exchange, to pass another feature of Obamacare requires a push.

That's just the point: It was Otter's leadership, fueled by the undeniable logic of his position, that carried the day on the exchange issue.

Why doesn't he urge lawmakers to address Loertscher's proposals - either now or in a special legislative session this spring?

Can Idaho's millionaire chief executive be so indifferent about saving 600 Idaho lives?