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Idaho Lawmakers Opt to Not Opt Out

Wait and see on health reform before jumping to legislate

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Idaho Lawmakers and lobbyists agreed Wednesday that it was too soon for Idaho to take action on federal health care reform proposals, including the possibility of opting out of a potential public health insurance option.

On Wednesday, Nov. 4, a panel of health industry executives and financial leaders gathered before a legislative health care task force in the basement of the Idaho Supreme Court Building. The agenda focused on whether or not Idaho should opt-out of a government-run health plan, whether Idaho, like Arizona, should consider amending the state Constitution to allow citizens not to participate in a government-run plan and what could or should be done about health care in Idaho.

With the exact nature of federal reforms still hazy, the committee leaned toward a wait-and-see approach.

"I think it's very difficult to pin down the pros and cons on a piece of legislation where the details are not nailed down yet," said Susie Pouliot, CEO of the Idaho Medical Association. Pouliot pointed to another problem—a high priority for the IMA—that Idaho does not have an adequate number of physicians for patients.

"We are woefully low on patient to physician ratio. We very strongly support initiatives to expand access to medical education with residency programs and any sort of tools we can use to get more physicians practicing in Idaho," said Pouliot.

Weighing in on speakerphone from Washington D.C., Joy Wilson of National Conference of State Legislatures discussed the current House health care reform bill, H.R. 3962. With the details changing daily, the bill is still being developed and may not to be introduced until early 2010.

"The biggest outstanding issues that I'm aware of are abortion language; there are members that want to codify a Medicare provision that says no federal funds could be used to fund abortion. There is language in the House bill that prohibits the use of federal funds to fund abortion, however there are members that don't feel that the language is strong enough. The second issue is treatment of undocumented immigrants. Under the current bill, an undocumented immigrant could use their own cash to purchase coverage. Some of the members want to preclude that as well," she said.

In response to an inquiry by Rep. John Rusche about any "scuttlebutt" on what would come next if the bill fails, Wilson defended the current bill.

"I want to believe that before it fails somebody is going to blink. That's really the question. Is somebody going to blink or is everybody going to stand there and wait and run out of time? Because for all of the issues where there are problems, there are proposals to address them—it's just that none of them have a majority vote at this time," said Wilson.

Steve Millard, president of Idaho Hospital Association doesn't believe the public option is viable for hospitals, but he takes the stance that something needs to change.

"Hospitals are for reform with the caveat that it's done right. Having been with the association for the last 35 years, a lot about our system drives me crazy. We need to do reform. We need to do real reform. We don't need to just cut reimbursement or just insure people—there's a lot more to it."

Steve Thomas of the Idaho Association of Health Plans holds a similar opinion on the feasibility of a public option.

"I think its safe to say that my members do not care for the public option. It has lots of problems that we disagree with. But in the broader sense, to opt in or out of entire health care reform, my answer is it's just too soon to tell. It's just too many moving parts and frankly we think over time, the devil is in the details," he said.

While most of the discussion focused on whether Idaho should participate, Thomas addressed the speculation taht Idaho might follow suit with Arizona, raising the question as to whether "a state constitutional provision trumps a federal statute." If passed in November 2010, this amendment would excuse Arizonans from participating in any compulsory government health plans. As well, David Irwin, director of communications of the Idaho AARP office doesn't think state constitutions should be tampered with lightly, citing "severe and unattended consequences."

Irwin noted that the 18,5000 AARP members in Idaho spend an average of 30 percent of their income on health care expenses.

"High prescription drugs costs are forcing many to choose between filling a grocery cart and filling a prescription," said Irwin. "AARP recently stated that Idaho is on a crash course for a health care disaster. A public option funded by premiums could allow the growing ranks of the uninsured a viable and affordable option."

Tom Shores of the Idaho Association of Health Underwriters was incredulous about the benefits of the plan. "If people want health care but can't afford it, why would we want to encourage people to pay more money for a plan that may cover less? It doesn't make any sense," said Shores

Also speaking for the IAHU, Scott Leavitt offered suggestions on what else could be done. "We're overweight. We smoke. We don't take care of our bodies. There are ways to incentivate employers who have wellness programs. We can make a big impact by making sure if people take care of themselves through prevention and proper lifestyles."

Taking this one step further, Leavitt suggests increases "sin" taxes on tobacco and alcohol which would both deter bad behavior and increase health care funds.