Health care, and Idaho's Statehouse of denial

Here's a draft of our Sunday editorial on the health care ruling — and its implications for Idaho.

Idaho politicos have spent two years viewing President Barack Obama’s health care law with scornful suspicion.

That is, when they haven’t covered their eyes and tried to wish the law away.

State lawmakers spent the 2011 session indulging in constitutional conceit, convincing themselves that states possessed the power to “nullify” any federal law that they don’t like.

In 2012, these same lawmakers ducked the idea of creating a state-run health insurance exchange — an online marketplace to enable individuals and small businesses to shop for insurance, and a component of the federal health care law. They explained away the dodge by saying they wanted to see how the Supreme Court would rule on health care. Clearly, many lawmakers fully expected the court to toss the law aside.

We all know how that worked out. On Thursday, the Supreme Court kept the health care law on the books in a 5-4 decision.
Despite their infatuation with nullification, it would be unfair to beat up Idaho lawmakers for guessing wrong on the health care ruling. The decision, and Chief Justice John Roberts’ emergence as the court’s swing vote, confounded many observers.

But it’s the job of elected officials to prepare for any outcome, not to govern based on partisan hopes and wishes. It’s as if Idaho political leaders — fervently opposed to the law they call “Obamacare” — refused to even entertain the possibility that the law might actually hold up in court.

Where are we now?

A health care exchange is coming. But most likely, the federal government will run it. That’s the hole Idaho lawmakers dug for themselves, by refusing to set up an exchange — and accepting “Obamacare” grant money to do it. If the state doesn’t cobble together a health exchange framework by January, the feds may establish their own exchange.

“I don’t want to say we’re unprepared,” Sen. Dean Cameron, R-Rupert, told the Post Register in Idaho Falls Thursday. “We are somewhat prepared, but we are dramatically behind the curve.”

Cameron owns an insurance agency, so we trust he knows what he’s talking about. But this is a predicament the Legislature inflicted upon itself.

The health exchange might not even be the biggest decision stemming from the court ruling. Idaho must decide whether to expand its Medicaid program to cover more uninsured Idahoans.

The Supreme Court ruling left that option to the states. Idaho could choose not to expand its Medicaid program — with no repercussions for the program and the 238,000 Idahoans now under its care.

From the standpoint of state sovereignty, this is good news. But it leaves Idaho facing a big decision.

At the outset, the feds would pay 100 percent of the costs of Medicaid expansion, covering perhaps an additional 80,000 Idahoans by 2014. After 2020, the state would have to pick up 10 percent of the costs for this added caseload — a generous match, considering that the feds pick up about 70 percent of current Medicaid costs.

Does Idaho want to take on more Medicaid patients — when the state’s ever-growing program costs now total $474.1 million, or 17.5 percent of the general fund?

Or does Idaho leave these patients to fend for themselves — and perhaps go to the payer of last resort, a growing catastrophic fund covered by state dollars and county property tax collections?

The answer will affect state budgets, and thousand of Idahoans, for years to come. It deserves thoughtful discussion and serious number-crunching.

Gov. Butch Otter did nothing to set the tone Thursday, issuing a canned and predictable statement decrying the Supreme Court ruling and calling for Congress to repeal the health care law.

Otter phoned in his statement from a week-long horseback trail ride, according to the Spokane Spokesman-Review. The bigger fact is that his leadership on health care was lacking long before he saddled up this week. Otter used his 2011 State of the State address to push for nullification — as far-fetched a fancy as repeal is now. Otter voiced support for a health exchange before the 2012 session, only to shrink away as opposition mounted in the Legislature.

Now, Idaho needs to get out of denial and get serious about health care issues. Is Otter up to the job?

Not all of us were in denial

I agree that the Legislature, and especially the majority legislative leaders were/are in denial. The House leadership seemed to treat it more as a campaign issue that a serious problem for Idaho's businesses, healthcare providers and hundreds of thousands of citizens. Even now the cry is "just hold out, Mitt will win and it will be repealed".

But not only are they in denial about the ACA, but about the difficulties and problems in healthcare financing and delivery. And that the industry is rapidly trying to move into the future, and only asking for a small bit of cooperation.

So how does the political posturing help Idahoans? How is that going to work for Idaho businesses? For the medical providers? For the taxpayers footing the bill for indigent care and through the cost shift?

The Departments of Health and Welfare and Insurance made real attempts to build a path to compliance. The Governor's office was tepid in support at best. And the Legislative Majority slammed those tries as you note above.

So are we prepared? not likely.

But if we can get past the presidential politics rhetoric and focus on the needs of Idahoans, we maybe can start to catch up.

To answer your last question Kevin,



Obamacare! Stop Obama's Statist aspirations. Allow individuals to make their own decisions as the nations Founders intended. Stop the greatest tax increase in the history of the Republic! Stop the destruction of the system that allows the USA to be the home of worlds leading providers of health care. Get the Marxist SEIU out of health care!

How could you possibly know

How could you possibly know what the nation's founders wanted in relation to health care? There was no such thing as health insurance back then and the medical treatment available now didn't exist, either. Too bad that these "world leading providers" are only affordable to those with very good insurance and/or big bank accounts!

Are you naturally dense?

Or have you been surgically enhanced? If you aspire to a medical care system that is eventually equal to that of Cuba, vote for Obama.

More denial: they ran off all the HMOs & wrecked our healthcare passing the 1994 "any willing provider" act to run off the HMOs, the legislature effectively nixed any healthcare competition for Idaho. Dumb...very,very dumb.

It has cost Idaho small businesses and working folks dearly, ended HUNDREDS of existing biz-healthcare plans, and raised property taxes for the hospital-indigent reimbursement fund.

Plus, they cannot do what Florida & other states are now doing with instate HMOs on their Medicaid costs...saving hundreds of $$ millions & $$ billions yearly.

if you are lucky enough to survive an HMO

My Dad's insurance in highschool was an HMO...worst medical care ever....they ran off the HMO's when Kasier wanted to come here...and folks who had been harmed, and the families of those killed by negligence testified by the many..with their horror stories and Idaho listened..HMO's care nothing for the people they insure...just what they can do to make a profit..and pray their greed doesn't get them caught for murder. I won't be in an HMO ever again....all I ever saw was a 'nurse practioner' what a joke they are...should be good to tell you you have a cold..that is about it. A nurse with some glorified 'Masters' degree does not a PhD can have you HMO..I want to keep living.

Appearently you are the dense one.

The idea that the Founders considered how to provide health care is ludicrous. The facts (you may have heard of those) is that the market can not provide affordable health care. The market can not control costs. Our non-system is the most expensive of any industrial democracy and for all that money, we cover less people than any of those same industrial democracies. So what's your plan? To continue to leave health care to the tender mercies of insurance companies and if people can't afford care, let them die? Another inconvenient fact is that a single payer system is the most effective and efficient way to provide care. And no, it's not perfect but it's the best way to do it and that's not a philosophical position, it's a utilitarian practical position - you know reality - what a concept eh?

If that "Liberal Lobotomy"

cost you more than two bucks, you got ripped off.

Actually, the founders appeared to know about health insurance

John Adams even signed an iindividual insurance mandate into law that required seamen to purchase hospital insurance.

There are very few Merchant Seamen in America today

However I am sure you are happy with your mandated, employer collected tax, to pay for your "John Adams mandated insurance" if you happen to be a Merchant Seaman. By the way, the Merchant Seaman's Tax has long since morphed into the US Public Health Service.

If wishes were horses...

Then dreamers would ride off into the sunset and conveniently ignore reality. I would not categorize the governor and the republican majority in the legislature as dreamers though. They are actually more like ostriches who have their heads firmly entrenched in the sand and often loudly proclaim a longing for days of yore when simple times allowed simple minds to get by without so much effort or thought. I suspect they will eventually do whatever the insurance lobby tells them to because they are incapable of independant thought or action and also because they wish to keep those with deep pockets happy at any cost to their constituents. Stay tuned.

Simple minds and ostriches

Yes, I would say that describes our state legislators very well!