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Waiting for D.C.

On bailout and way forward, ground has shifted under Idaho

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Idaho's poor, overwhelmed House Health and Welfare Committee is drowning in numbers. $41 million. $139.6 million. $1.8 billion.

Wait a minute, Mountain Home insurance agent and committee co-chairman Pete Nielsen interjected during a recent meeting. You mean we control part of the Medicaid budget?

It's a big, confusing, scary budget, but Nielsen, now in his fourth term, has voted on Health and Welfare spending at least seven times. He has surely seen the little pie chart showing that 54 percent of the Medicaid expenses are state, not federal mandates.

There are only two pieces of the pie.

Later that same Thursday, Unda' the Rotunda attended an Idaho Health Care for All meeting in a basement near the Capitol Annex.

While discussing ways to encourage universal health coverage in Idaho, Rep. Sue Chew, a Boise Democrat and member of the Health and Welfare Committee, gently reminded the crowd of doctors and healthcare activists to approach legislators at a very basic level, sensitive to each lawmaker's worldview and life experience.

"This is not a year to get universal healthcare in Idaho," Chew said.

The best hope for this year is keeping Idaho's safety net for the poor whole, she said.

Rep. Fred Wood, a Republican and medical director at Cassia Regional Medical Center in Burley, had said essentially the same thing earlier in the day.

"I don't see anything—health insurance, whatever—getting better," Wood said after the committee budget briefing.

Yet Gov. C. L. "Butch" Otter is pushing ahead with his own, nearly 2-year-old healthcare reform effort. In August 2007, Otter convened a healthcare summit that coalesced into a "Select Committee" that in October, handed him a 30-page report.

The vision of the governor's healthcare committee is that every Idahoan have access to healthcare in what is called a "coordinated system built upon a primary care medical home"—a main doctor that can consolidate care, in particular for people with chronic illnesses, and also serve as a health coach.

Otter's committee also stresses personal responsibility and recruiting more doctors and nurses to the state.

The report recommends extending Medicaid coverage to all of Idaho's children but acknowledges no way to fund that goal.

The one solution Otter is touting, mentioned in his State of the State speech: a Web page for people aged 25 to 40 that is hidden on the Idaho Department of Insurance Web site.

It has a name: "Healthy Idaho," and it got a full paragraph in the State of the State speech, but this solution to Idaho's health insurance gap amounts to a light advertising campaign for individual, high-deductible plans from Blue Cross, Blue Shield and Primary Health.

Try to find the page on the state's interweb.

Joyce McRoberts, the former House majority leader who is Otter's part-time point person on healthcare, said more companies will participate in the, uh, Healthy Idaho Web site thing and the state will roll out some advertising for it.

Meanwhile, the Legislature's permanent task force on healthcare continues to meet, waiting for some direction from the Governor's Office on big ideas. Legislators have floated ideas for pooling teachers and universities to save on health insurance costs and have changed the way the state views mental health services, though some of the gains are victims of this year's budget cuts.

In his inaugural speech, President Barack Obama, who has talked a lot about healthcare reform, said: "What the cynics fail to understand is that the ground has shifted beneath them, that the stale political arguments that have consumed us for so long, no longer apply. The question we ask today is not whether our government is too big or too small, but whether it works."

That line could have been directed at Idaho; the piecemeal efforts to reform our healthcare system in this state without any discomfort to hospitals, insurance companies or docs may no longer be relevant.

The ground has shifted in Washington, D.C., and big ideas for healthcare reform should be trickling down to our state in short order.

The ironic thing is that Otter, the Legislature and the Department of Health and Welfare are basically standing with their hands out waiting for the dough, without saying so.

The $41 million referenced above: That's the gaping hole in Otter's budget recommendation for next year's Medicaid bills. And $139.6 million is the amount, after federal matching grants, that Health and Welfare will either stiff hospitals with or, more likely, cut services to the poor to make up, if the $41 million is not found.

While far from a sure thing, the state is expecting some beefed-up matching grants for Medicaid spending in the stimulus bill that Obama is pushing on Capitol Hill.

"They don't want states to take people off the Medicaid rolls and restrict eligibility," Health and Welfare spokesman Tom Shanahan said, adding that Idaho is already the third most restrictive state in which to get Medicaid benefits.

And what about the $1.8 billion?

Dear reader, you don't want to know what this represents, but suffice it to say, if we keep getting sicker, it's the tip of the iceberg.

See the report at citydesk.boiseweekly.com.