The Right Campaign (But the Wrong Candidates)

Are Idaho's uninsureds the underestimated voter bloc in the race for governor?


A few minutes into an Oct. 9 Idaho gubernatorial candidate forum, it became abundantly clear that the one person who should be running for Idaho governor isn't on the ballot. Of course that also means that the men—including incumbent Gov. C.L. "Butch" Otter—who are on this year's ballot have no business leading the state into 2015 and beyond.

Dr. Ted Epperly has no intention of being Idaho's chief executive. That's our loss. The professor, author and Army veteran speaks plainly with significant authority; he also gets along well with both sides of the political aisle—he helped the U.S. Department of Health and Human Services craft the Affordable Care Act and was handpicked by Otter to be part of a working group to examine possible Medicaid expansion.

More importantly, Epperly is a Boise-based family physician and director of the Family Medicine Residency of Idaho. He's also the past president of the American Academy of Family Physicians, representing more than 100,000 doctors nationwide.

Epperly is particularly passionate about Idaho's uninsured and underinsured; so it served to reason that as gubernatorial candidates got lost in their rhetoric (which was often enough) at the Oct. 9 City Club of Idaho Falls debate, it was up to Epperly to set them straight by presenting reason and logic to the proceedings.

While there are at least a half-dozen issues being bandied about the candidates this campaign season, the Medicaid expansion debate might be the secret equation to whether Otter will be successful in securing a third term.

Consider the numbers:

It's estimated that anywhere from 84,000-104,000 uninsured Idaho adults are eligible for Medicaid under ACA guidelines. They live in fear of a possible health crisis that could financially ruin their family. It's also fair to assume that of that 104,000 there is a significant number of voters who consider themselves to be politically independent.

Next, look at Otter's winning margins in his previous re-elections: approximately 118,000 in 2010 and approximately 38,600 in 2006.

Pundits have yet to hint that Idaho's uninsured could help decide the 2014 election for Idaho governor; but the Gem State's uninsured adults may be the most underestimated demographic—and a huge voting bloc that hasn't yet been realized.

Simply put, Otter could be particularly vulnerable if tens of thousands of uninsureds were motivated enough to show up at the polls Tuesday, Nov. 4, joining other voters with their own views in opposition to the governor, including inadequate education funding, the same-sex marriage debate and Idaho's private-prison scandal.

The usually gracious Epperly was quick to compliment all of the candidates, calling them "courageous" for being a part of the political process. The physician said it was important, though, for the candidates to give a voice to Idaho's uninsured.

"The uninsureds are not strangers," he said. "They're citizens; they're our neighbors, and in too many instances, they are us."

Epperly points to what he calls two easy examples of Idahoans who have fallen through Idaho's health insurance gap:

For instance, he asks us to consider the Smith family (two adults, two children), which has an annual household income of $23,000. The kids could be eligible for care under the Children Health Insurance Plan (aka CHIP). Coverage for the adults through the health insurance exchange would cost somewhere around $11,000, but the Smiths don't have enough income to be eligible for a tax credit through the exchange (the ACA was designed to send such families to a Medicaid program, which Idaho doesn't have). Bottom line: the Smiths can't afford an annual out-of-pocket premium of $11,000.

Meanwhile, consider the Jones family (again two adults, two children), which has an annual household income of $32,000; that's about enough to make them eligible for a $10,000 credit, decreasing their annual premium of $11,000 to $1,000

In 2012, Otter formed a 15-member working group to examine the risks and benefits of a possible Medicaid expansion in Idaho. The task force included representatives from Idaho counties, the departments of Corrections and Health and Welfare, elected officials, hospitals and doctors—one of the physicians was Epperly.

"We met three times in 2012," Epperly said, "and in the end, we voted unanimously to recommend to the governor that he move forward with a plan to expand Medicaid."

The task force drilled into five possible options for Idaho:

No. 1. Do nothing.

No. 2. Redesign Idaho's catastrophic and indigent care funds, the taxpayer-funded (and very leaky) safety nets that attempt to plug the financial holes when the uninsured end up in emergency rooms.

No. 3. Redesign the Medicaid system, bringing in more than $9 billion in federal funds over 10 years.

No. 4. Take the federal money, but buy private coverage for eligible families rather than add them to the Medicaid rolls.

No. 5. Take the federal money, but make direct payments, as needed, to primary care physicians.

Otter's task force ultimately decided on No. 3—but that wasn't the answer Otter wanted to hear.

"I was worried about how we would pay for it," said Otter during the Oct. 9 debate.

Undeterred, the task force reconvened and met one more time in 2013 and twice earlier this year. Most recently, the group voted 10-3 to once more tell Otter that he was best advised to pursue Medicaid expansion. The three "no" votes came from a trio of Republican members of the Idaho House—Reps. Tom Loertscher, Mike Moyle and Steven Thayn, who insisted that the issue would be "dead on arrival" if presented to the GOP-controlled Idaho Legislature.

"I understand that the infusion of a large sum of money creates economic growth in the short run, but I am concerned about the long-term sustainability of this plan," said Thayn after the August vote.

"The Legislature is not going to approve an expansion plan," said Moyle.

"We need more education, but I don't know if that will work in this political climate," said Loertscher.

Apparently those three voices were all that Otter needed to hear before sidelining any possibility of Medicaid expansion for another year.

"Where have we gone off track on any of this?" asked an exasperated Epperly. "Somewhere along the line, it has become politically popular to call the federal government evil."

Throughout the current campaign season, Otter has indeed taken every opportunity to spin the Medicaid question into a chance to attack the federal government.

"When we launch into an entitlement program, we need to know it's sustainable," Otter said in the Idaho Falls debate. "The federal government can't be depended on. After a while, they usually cut off the money."

Otter's remark went unchallenged by Democratic challenger A.J. Balukoff at the debate.

In fact, several of Otter's comments weren't challenged during the Oct. 9 face-off.

On education: "I can't think of a single instance where an Idaho teacher was replaced by technology." (The comment came just a few minutes after Otter described a scenario where "a teacher in Meridian teaches Latin to students in another classroom on the other side of the state.")

On the effort to add the words "sexual orientation" and "gender Identity" to the Idaho Human Rights Act, Otter dropped a mini-bombshell when he said he expected Add the Words legislation to receive a full hearing in the 2015 session of the Idaho Legislature. Instead of challenging Otter to advocate for antidiscrimination legislation, Balukoff only said, "I'm glad to hear that."

Otter got the last word on the subject when he sniped at Add the Words advocates by adding, "All I ask is that they show some respect to the Legislature."

Therein lies Balukoff's weakness: an inability to dance the political two-step with the affable cowboy. In spite of nearly 11 months on the campaign trail, Balukoff's public speaking skills still aren't a match for the adept Otter, who never met a microphone he didn't like.

Even the Idaho Statesman, in its endorsement of the governor's re-election to a third term in an Oct. 8 editorial dubbed "Otter 3.0," reserved its strongest praise was for how Otter "pivots in perilous times" and stated it had "yet to identify anyone as prepared for the next four years as Gov. Butch Otter."

"There are solutions out there for Medicaid expansion," wrote the Statesman editorial board, presuming that Otter might make a 180-degree pivot sometime in the next four years. A closer look at the Medicaid issue reveals that solutions have indeed already been presented to Otter—twice—and he'll tell anyone who will listen on the campaign trail that he was proud to reject his own working group's recommendation on both occasions.

Which raises the question: Could tens of thousands of uninsured Idahoans coalesce as an anti-Otter voting bloc come Election Day? Or are they still OK with "pivoting in perilous times?"