Idaho House panel backs health gap coverage plan after emotional hearing

Feb. 08--For the first time, an Idaho House committee has voted in favor of a plan to provide coverage to some of those in Idaho's health coverage gap.

The House Health and Welfare Committee's 7-5 vote in favor of Gov. Butch Otter's Idaho Health Care Plan sends the bill to the full House. It would provide coverage for about 35,000 Idahoans -- about half of those who now fall into a coverage gap because they make too much to qualify for Idaho's limited Medicaid program, but not enough to quality for subsidized insurance through the state health insurance exchange.

At the close of the committee's second lengthy hearing on the bill in two weeks, Rep. Eric Redman, R-Athol, spoke passionately in favor of the plan. "You know, I've been here four years, and I'm not saying we're kicking the can down the road -- we're kicking the barrel down."

That "barrel," he said, is full of people in Idaho who fall below the federal poverty line -- the ones the plan would allow to qualify for tax credits that allow them to buy subsidized private insurance through the exchange. They are now turned away because their incomes aren't high enough.

"Everything I hear -- it is an Idaho plan," Redman said.

The proposal relies on seeking two waivers from federal rules: One to allow the 35,000 Idahoans whose incomes fall below the federal poverty line to qualify for insurance subsidies; and the other to allow the state to shift 2,500 to 3,500 of the sickest Idahoans who now have private insurance through the exchange onto Medicaid. State officials estimate that moving those very ill or dying patients off the state insurance exchange will lower costs for everyone else -- by enough to cover the new subsidies for low-income folks.

Several committee members said that crossed a line for them -- they didn't want to see any additional people moved into the Medicaid program. Idaho already has declined to expand Medicaid under the federal Affordable Care Act, which would have covered all 78,000 in the gap group at little or no cost to the state, out of antipathy to Obamacare.

Rep. Bryan Zollinger, R-Idaho Falls, who acknowledged that the birth of his first child years ago was paid for by Medicaid when he was uninsured, said he just can't stomach any additional role for government in health care. "All government has done for the last 60 years is screw that up and made it worse and worse," he said, "and we're fooling ourselves if we think another government solution is going to fix the problem. We have to get out of the way."

Redman said he views the care for that group of very sick Idahoans as an appropriate role for the federal government, in part because the federal government controls more than 60 percent of the land in Idaho.

"If we didn't have 62 percent of our lands under the federal control, maybe we could have the income coming in and the taxes and the like where we could afford more Idaho plans," Redman said. "But we don't. Massachusetts is first in medical doctors per population, we're 49th. Massachusetts doesn't have those 62 percent of lands covered under the federal government."

Rep. Fred Wood, R-Burley, the committee chairman, noted that the recent Boise State University Public Policy Survey showed 75 percent of Idahoans want lawmakers to act on this issue. "Kicking the can down the road is no longer a viable option," he declared.

The panel heard three hours of public testimony on Wednesday, nearly all of it in favor of the plan; it also held a multihour hearing a week earlier, just to allow committee members to question state officials about the details of the plan. Among those speaking in favor of the bill on Wednesday were representatives of the Idaho Medical Association, Idaho Hospital Association, Blue Cross of Idaho, health care advocacy groups and private citizens, many of whom, with great emotion, shared their personal stories of falling into Idaho's health coverage gap.

Jessica Rachels, of Sandpoint, told the committee, "My husband is self employed, and we're both in the coverage gap. ... Today, thousands of Idahoans are unable to access the tax credits because their income is too low. The Idaho Health Care Plan would solve this unfairness, allowing many Idahoans access to tax credits, myself included."

She said, "I am a full-time caregiver for my daughter who uses a wheelchair, and my father, who also has a disability. ... For our family of seven, it's a choice between a $100 doctor's visit or buying groceries. ... For children to grow up successfully, they also need to have healthy parents. Through the Idaho Health Care Plan, working Idahoans will have access to care and will be less likely to incur medical debt while uninsured."

Berniece Olivas, of Boise, said she works four part-time jobs and can't afford the medical supplies and treatment her husband needs to treat his diabetes; it's now progressed to the point that he's suffered an amputation, and the family has run up $90,000 in medical bills in the past year. All of this, she said, "will cost the state far more than helping him manage his care a year ago, five years ago, when it could have saved his life."

Cheryl Slavin's voice broke as she told the lawmakers, "I work, and I would like to be able to keep doing so, but without my medications, I am disabled. ... I'm a likely candidate for repeated hospitalization. ... This is one example of what it is like to be in Idaho's insurance gap."

Slavin said, "It is a gross injustice. ... I need more than good luck and well wishes to get through this."

Several advocates objected to the late inclusion of work requirements in the bill, but otherwise supported it; the state Department of Health and Welfare says about 700 Medicaid recipients would be subject to the new work requirements.

Rep. Ilana Rubel, D-Boise, said she had concerns about work requirements and how onerous they would be for disabled or ill patients. But, she said, "I can only vote on the bill that's in front of me, and I think the bill that's in front of me is a very substantial improvement on the status quo. ... It will save lives. ... We either do something or we do nothing, and this is a whole lot better than doing nothing."

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