Name your poison: education funding; a possible takeover of federal lands; the private prison debacle. The 2014 Idaho Legislature is already well-stocked for melodrama. But the Affordable Care Act and, in particular, a possible Idaho expansion of Medicaid, is certain to provide much of the verbal fireworks.
And with a scant 49 days before lawmakers are gaveled into session, a rare bipartisan dialogue took place Nov. 18 at the Boise Public Library's main branch. And while every one of the participants at the event--sponsored by Idaho Health Care For All--agreed that reform was necessary, there was a wide range of opinions on whether Medicaid expansion was the right path for Idaho.
"I'm not an advocate for Medicaid expansion, nor am I a detractor," said Iona Republican Rep. Tom Loertscher, chair of the House State Affairs Committee. "It's a mixed blessing for Idaho. Everything's up in the air at the moment. The size of expenditure makes expansion unsustainable in the long term without a huge change in the way things are done. Every dollar spent on Medicaid is a dollar not spent on education."
Proponents say that an Idaho expansion would provide care for as many as 104,000 uninsured Idahoans, a number that Corey Surber, executive director for Community Health and Public Policy at Saint Alphonsus Regional Medical Center, said would include quite a few working families.
"These are hardworking Idahoans," he said. "These are the people who change your oil, who serve you food. They have little access to preventative sources, and no access to primary care. Indigent costs hit the state, largely from crisis care."
James Baugh, executive director for Disability Rights Idaho, insisted that Medicaid expansion needed to go one step further, especially with regards to mental health. Baugh said of the 75,000 Idahoans who struggled with severe mental illness in 2012, only 9,000 were covered by the current Medicaid scheme.
"The system is in crisis. And the only game in town to fix it is Medicaid redesign," said Baugh.
Alex LaBeau, president of the Idaho Association of Commerce and Industry, one of the most influential lobbying forces at the Statehouse, joined the dialogue by saying that while the United States has the second-highest health care expenditures in the world--a whopping 17.6 percent of its gross domestic product--the cost was not reflected in the quality of care.
"We're spending a lot and getting a little," said LaBeau.
But when it comes to a possible expansion of Medicaid, LaBeau stood firm on what he called the unsustainability of the solution.
"It's like shuffling the deckchairs with the symphony playing in the background as the Titanic is going down," said LaBeau. "We're just shifting cost to another tax source that we're all paying for."
LaBeau added that expansion would result in "marginally better care for a less expensive cost to the state of Idaho, but not to the nation." The IACI president cautioned lawmakers to closely examine how other states have already handled their own expansion, and then ask themselves two basic questions:
"Is there a way that we can make this system better for the citizens of Idaho? Is it fair to the taxpayers?" asked LaBeau.
But Baugh insisted that even if the 2014 Idaho Legislature chooses to move forward with expansion, the state would not be permanently locked into the system and could opt out at any time. "At least in theory," he added.
United Vision for Idaho Executive Director Adrienne Evans, who helped arrange the public dialogue, emphasized Idaho's cost of doing nothing.
"We will gain nothing from not doing this," she said. "Either dollars flow elsewhere or they flow to Idaho."
Dr. Louis Schlickman, co-chair of Idaho Health Care For All, echoed Evans' argument.
"Not doing anything is a horrible idea," said Schlickman.