Fighting Prescription Drug Abuse in Idaho


As the Latah County Coroner for 15 years, and as a practicing family physician, I was well aware of the prescription drug abuse problem long before I came to the Idaho legislature. Over 200 Idahoans die annually from prescription drug overdose. At the same time, there is increased pressure to treat chronic pain.

Complex problems deserve careful consideration, and I have come to realize the legislature and the laws we pass are often blunt instruments. Our founders did not make it easy to pass laws and it should not be, for laws can harm as well as help. A colleague in the Idaho Senate had a constituent approach him about their young sons tragic accidental overdose death. He showed his proposed solution to me, a law requiring prescribers to access the prescription data bank before writing a controlled substance prescription under threat of penalty. Other states have adopted this. I supported a different approach.

In 2011 I asked representatives of the Boards of Medicine, Nursing, Pharmacy, Dentistry, as well as representatives of the professional associations to meet and address this problem. It is called the Prescription Drug Abuse Prevention Work Group(in short: Rx Work Group). We have met quarterly, I usually attend by teleconference. Some good ideas have been brought forward.

Understand that we have a tool in this battle. Idaho has a Prescription Monitoring Program (PMP), administered by the Board of Pharmacy. The Rx Work Group found we had to change the law to allow sharing of information between the professional boards. We did this. We also advocated that all practitioners who have a Controlled Substances Permit from the Board of Pharmacy be required to register with the PMP. This law has also been passed. I’m not opposed to all laws, but I believe it’s important to act responsibly, not just pass sweeping legislation then beat one’s chest about solving a complicated problem, when in fact, the culture needs to change. My interest was to get the tool (PMP) to be used to improve the quality of prescribing by practitioners. To do this we needed a common agreement about the goals of prescribing controlled substances and cooperation between the various licensing boards to improve the prescribing practices of their licensees (doctors, dentists, nurse practitioners, pharmacists, etc.).

So in 2015, with the input from board directors and professional organizations I drafted a statement of purpose and guidelines for practice. This was adopted as a base for the ongoing quality improvement process to be administered by the Office of Drug Policy.

There has been ongoing surveillance of prescribing and constant feedback between the PMP, Board of Pharmacy, Board of Medicine and Board of Dentistry, and Nursing, all in an effort to make these improvements. We struggled to gather the appropriate data to make sure our efforts had any effect. Many times, the death certificates (filled out by county coroners) have incomplete information, so that is another part of the loop that needs to be closed.

I hope the Governors Office of Drug Policy (ODP)can shepherd this effort. Instead, I see their focus to be building a wall around Idaho as the states around us liberalize the use of marijuana. ODP works for the governor, not the legislature, but that would have been an effort of mine in the future, had I been relected.

I believe prescription drug abuse, the irresponsible prescribing by practitioners, and the culture of inappropriate pain treatment has done more harm to our state than illegal drugs have. But maybe the work can continue. It is worth it.

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Otto Schmidt, right over from Germany, a Great Grandfather I never knew

Otto Schmidt, right over from Germany, a Great Grandfather I never knew

Our legislative leadership will sometimes schedule events to educate us or augment our skills as legislators. This last session we started with a half day mandatory meeting on civility. I guess they thought we needed the help. Early in the meeting a leader had asked us to consider the concept of integrity. How would we define it? I listened but did not speak. My story would have taken more than a few words.

In my thirteenth summer, between eight grade and freshman year at high school I was sent up to Idaho to work with my grandfather.



I’m sure this was my father’s idea and he got begrudging agreement from mom. Dad could see I needed something more than sitting around a Southern California town as my adolescence blossomed. I thought I might spend the weeks on the remote retirement ranch but Henry and Helena had agreed to be range riders for Helena’s cousin on the Cuddy Mountain range. They were familiar with this ground, having the Forest Service range permit before, and when the younger cowboy backed out at the last minute, Henry agreed to push cows over the mountain in his 68th year. And I was along for the ride.

Grandpa Henry Schmidt

Grandpa Henry Schmidt

They got me a good cow pony, Ginger, and I was on her every day. From the first time Henry saw me horseback he instructed, “Sit up straight, goddamit, yore gonna lame yore horse.”

I straightened my back and later asked what my posture had to do with a horses hoofs. “It’s all tied together dammit.” He’d smile. “She’s as reliant on you as you are on her. You sit crooked or slumped like a wet noodle, she’s not gonna walk right. She’ll go lame. Hell, I seen it.” He didn’t mind my honest question. I worked on my saddle posture.

We were up on Cuddy Mountain for three weeks moving cows from one side of the high mountain range to another. On our second to last day up there Henry called me out from the line shack. I did the dishes each morning in the wash basin on the wood stove and Helena dried while Henry saddled the horses.

This is Henry saddling up down on the Wildhorse

This is Henry saddling up down on the Wildhorse

“Dan, get out here!”

Helena said, “Uh oh.”

I came out with a dish rag. He was mad.

“Now I’ve tole you and I’ve tole you about sitting up straight. Look it what you done here.” He pointed to a small lump on my mare’s back. “Feel it.” I could feel it was swollen. “That’s what I been telling you. If you’d sit up straight this wouldn’t a happened.”

I blinked back tears of shame and said I’d do better. We left camp with the sun in the eastern trees, a warm day, me sitting straight but holding back. As we headed off to some grassy meadow where I knew not, Henry dropped back from Helena and came up beside me.

“When I saddled your mare this morning after I yelled at you I saw where the skirt on your saddle had been folded over yesterday when I saddled her. So that lump was my fault, not yours.” I looked over to his shadowed face under the stained felt hat. He grinned at me, the Bull Durham cigarette in the corner of his mouth. “You still need to sit up straight.” I nodded.

I’ll never forget my grandfather’s integrity. He had no need to set the record straight, owning his own mistake, to tell his teenage grandson the truth. But he did. And I’m better for it.

That fall, my father brought me in to the kitchen after a Friday freshman football game; I thought it was to be the usual rehash of what I could have done better, for Dad put great stock in my athletic future. But he told me that Henry had died on Thursday. He’d had a stroke on Wednesday and they took him to town but he died there in Council the next day. Dad said he waited until after the game to tell me so I could stay focused. I wished I would have known sooner.

Donald Schmidt, my dad in his after the war years

Donald Schmidt, my dad in his after the war years

We pass on so many things to those we love, to those we touch, ones we see every day. But the lessons we learn stay after. As I head into this advanced age I cherish the examples of wisdom and strength, and indeed the weaknesses and judgement of my fathers before. May I be so able.







Dad in his college years performing at Sun Valley

Dad in his college years performing at Sun Valley

Me with my first two (of four) daughters, Katy and Soona

Me with my first two (of four) daughters, Katy and Soona

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Push or Pull

Timber Hill Fire. Helena BLM District. Montana. August 1984.

It was August 2nd 1979 and we were about to head into a fire of incredible magnitude. But there was no smoke to be seen, just 4 or 5 helicopters in Bruce Meadows of the high central Idaho wilderness and all the overhead was off in a tent deciding what to do with our lives. Us pogues (that means grunt firefighters;  I was on the Payette Interregional Crew, now called “Hot Shots”) were laying on the grass of the warm alpine meadow waiting for the directions. We were about to go into the Mortar Creek fire, but that’s another story. When young men are idle there can be creative or destructive occurrences. This one was powerful for me.

The sun was warm, the grass soft, the packs all ready and we were just waiting. Amid the stories and teases and jokes a crew member looked at me and said, “You want to Indian Wrestle?”  Russ was about my size, probably more athletic, but I will acknowledge probably wiser. I could not resist. He explained the game. We both stand with front feet outside edges  side by side touching, against each other on the ground. We are faced 180 degrees to each other, like we are greeting each other and we clasp hands. It was almost like a secret fraternity handshake. We stood there, hands locked and whoever can get the other to move either of their feet from where they are placed, wins.  I thought it so simple.

I lost the first seven in a row to lots of laughter from the circle of pogues. I tried so many things. Each loss was an opportunity to learn. Push hard, then squat, and he would ease resistance and I would step off the back foot. I gave him no resistance, and he would pull me sideways. I won the eighth game but my victory seemed a fluke, since I lost the next five. I learned a valuable lesson I have carried forward into medicine and now into politics. A sense of balance, when to push and when to pull, and an awareness of ones opponents balance is the key to victory. And also, victory requires just a small movement of the opponent, just a small loss of their balance. But more important, one must keep one’s own. And even greater, to this day I respect and admire the man who gave me the opportunity to learn this, my opponent.

In medicine I studied this for years. I struggled to learn when to push the smoker to quit, when to wait. Or when to bring up the issue of weight loss, one of the many things we can change, but so many think they cannot; or do not want to.  I thought I got pretty good at it with patients. For that is where the real economy in health care lies, in behavior change, ultimately in thinking change. Some believe a person’s thinking never changes. I could not have been a doctor if I thought so. Now I am a politician.

I am in the legislature now and I have a new body I try to move. I am learning when to push, when to pull. More, I am learning to know when I am balanced and which way they may be leaning. This session was a good match, even if I didn’t get their feet to move. I learned a lot. But first you need to hear about the build up to it.

After the Affordable Care Act worked its way through the Supreme Court, four years ago our state faced a couple choices:  whether to establish a state or federal insurance exchange, and also whether to expand Medicaid eligibility. The governor set up two work groups to study the options. I was appointed to the Medicaid Expansion (then renamed Medicaid “Redesign”) Workgroup. We heard from many experts and eventually recommended full expansion. It would save the state approximately $50 million/year in the first three years, declining to a cost of $20 million per year by the 10th year. More, it would get rid of a burdensome indigent county process, enroll many working poor onto health insurance, as well as serve many probationers released into the community with minimal support. Finally, we believed it would give the state some leverage to ultimately control medical care costs by minimizing the cost shifting that uninsured costs bring into the system.

But the governor threw his weight in 2013 legislative session behind establishing the state based health insurance exchange. It passed, but the fight among the majority party was bitter. Many conservatives blamed my “conservative” colleagues for giving in to Obamacare.  I heard of three state senators who voted for the exchange that were sanctioned by their Republican Central Committees. I heard their arguments in the halls.  “I hate Obamacare as much as anyone, but at least this is an Idaho solution.” Their defensive rhetoric helped define their stance, then and now.

Right after the legislature had this painful battle, a couple of us minority party legislators met with the governor’s chief of staff. We pushed that now (the end of the 2013 session) was the time to push for Medicaid expansion. We know where the votes are; if your office gets behind it, we can do it.

He pushed back, “Why are you talking to me? This is your job to sell it to the legislature.” We left knowing it would not happen without their help. But I don’t think our feet moved. I know theirs didn’t.

So, we waited. And the governor appointed another work group to study the issue over the summer. I told the majority I would not be on it; others need to learn this issue. And the group made a very good recommendation, one I could support; it was along the lines of what Arkansas did. But three of the four majority party legislators voted against the recommendation, not because they didn’t support it, but because they did not think anything could pass the legislature.

The next year (2014) was an election year and the common wisdom is that nothing significant gets done when legislators are facing the voters. But we talked about it whenever we could. We had presentations from the Department of Health and Welfare that highlighted the benefits. Further, there was a summer project that the state used to apply for a State Health Innovation Program to revamp how healthcare is delivered and paid for, so the cost savings in health care we envisioned (reducing the cost shifting was just the first step) could be realized. I worked hard on that, but I did not push hard on my colleagues. They were firmly planted.

I got reelected, as did most incumbents (indeed, almost all the ones who supported the exchange were reelected), so I hoped maybe we could address Medicaid expansion in the 2015. But instead the push was to address highway funding. I accepted that it was an important issue, I had argued for it for years. So I waited again, another long year. We raised the gas tax and registration fees and got more money for roads and bridges. But I also got the opportunity, since I was on JFAC and did the Health and Welfare budgets, and I was also on the CAT Fund Board, to tell my colleagues in the Senate about the money we were spending. I knew we could be doing all this better. I was pushing, maybe pulling a little whenever I could. I did not think I was being ignored or minimized. I thought they were listening. Some were; I could tell.

So now we come to this session, 2016. I talked with many about Medicaid expansion for the uninsured before the session. All agreed it would not be an issue: election year, too hot a topic. I planned to let it go until 2017. Moreover, I was disappointed that we had lost the maximal savings for the Idaho taxpayer by foregoing the first three years when the Feds paid 100%. We were now down to them paying 97% (it never drops below 90%) and our savings are dwindling as the state picks up more.

Besides, the governor came out with a plan for “helping” folks in “The Gap”.  I saw it as a weak and wrong-headed plan. But it indicated their sense of the need. It was a signal to me, like a shift in my opponent’s weight. Was it time to push?

Before the session many of my Democratic colleagues were talking about getting personal bills printed to make a statement about the goals of our party. This becomes a bit arcane, so I must explain. All bills must be printed before they are acted upon. For a bill to be printed a chairman must allow a “print hearing” where there is no public testimony allowed, just the bill sponsor may speak. But a legislator can get a bill printed “personally” before the 12th legislative day.  I have avoided printing personal bills in my first five years; I thought they could be seen as statements in futility. I believed we should be working with our colleagues across the aisle to address the states problems, not posturing.

But the very first week of the legislative session in JFAC I learned that the CAT Fund would be returning $29 Million to the state general fund. Many folks who had previously been indigent were now getting insurance on the state exchange. In my first years on the CAT board costs had been rising dramatically, but now they had tapered and indeed were declining. We had appropriated $28M the year before, but county claims were diminished, there was money left over from the year before, so we could return it to the state general fund. This was another opportunity I would have to push, or pull on the body I served. I was on the CAT Fund Board, I would make the motion in JFAC and be able to speak to it, and I would carry the bill in the Senate and speak to it. If we speak, we have the opportunity to push, or pull. I had spent my first years in the Senate listening and building relationships. Speaking now would be an opportunity to test their balance; and of course mine.

But the window for opportunity is narrow, the end of the time to print personal bills was close. I decided to personally print the bills for Medicaid expansion. I had nothing to lose; get the two options from the two different governor’s workgroups out there. The recommendation from the group I was on became S 1204; the next work group’s recommendation was S 1205. We struggled for three days to update the fiscal notes and make them as accurate as possible. I wasn’t sure I could make the deadline and even argued what entailed a “legislative day”, but we got them in to the Senate Secretary and printed. I thought that would be the end of it. I expected my only personal bills to meet the fate of all Idaho Democrats personal bills: no hearing, no movement, just a weak wristed tug on a solidly planted foe.

When the CAT Fund rescission came before JFAC the next week I spoke to the committee about the $29M coming back to the general fund. Idaho was seeing fewer applications for indigent medical support and I believed this was a direct result of the courageous effort on the governor’s part, and the majority party in the legislature to enact the state exchange. When people get health insurance, taxpayers need to pay less for the uninsured. Idahoans had enrolled in the exchange at a remarkable rate. Everybody deserved the credit; I tried to make it as clear as possible how great their effort had been and what credit they deserved. I did the same a week later in the Senate when I presented that bill for them to approve. They listened; it passed unanimously.

The next week I got a message from the Senate Health and Welfare secretary that the chairman wanted my personal bills for the two options for Medicaid expansion to have a public hearing.  I clarified with her that indeed, a public hearing was intended; she confirmed the time and place. I let both the press and the supporters know. We had five days to line up emotional testimony that had been pent up for three years.

It didn’t go smoothly, for the chairman or me. I understood that the chairman was under pressure from his leadership. This is a painful discussion they have avoided for three years, solidly planted. His offer for a public hearing caught them off guard, so we needed to be firm but balanced. It was dramatic. Maybe that is what people are looking for in politics; so much is so boring.

More than a hundred came to testify, and only a few got to speak. The chairman decided at the last minute (I am sure under great pressure) that no vote would be taken. But the message was clear, from many Idahoans: insurance coverage for the Gap population is a matter of justice.

I had another thought. I had been on the CAT Fund Board for 5 years, reviewing the applications, and spending the taxpayers’ money on the folks who got injured or sick and did not have their own resources or insurance. It galled me to do this work on something I did not believe was the right way to pay for health care; after the fact, liens filed, bankruptcy insured. So why keep doing the work, reviewing the 1200 annual applications, going to the meetings, reading the litany of misery, when I believed so strongly there was a better way? So I announced my resignation from the CAT Board. I reviewed the statute and strongly suggested appropriate Senate appointment suggestions.  I don’t think a truly compassionate person could do this work and consider this system just or a good government process.

My resignation got little notice so I thought again, the fight was over. But since the bills had not been voted on in committee, they were not dead. It was an election year and all politicians pay attention to the election calendar. I was prodded by colleagues to call the bills from committee. They didn’t know exactly how to do this and neither did I, but Senate rules allow it, so I studied and prepared. We waited until after the final date for filing for office: maybe if some Republican Senators did not have primary challengers they would feel freer to have this discussion, like waiting for your opponent to relax a bit.

I called for the bills. The Senate Republican caucus prepared their response, since I let them know my intent; I thought it courteous. It was voted down on a party line. If 2/3 voted against the call for the bills they could not be called again, and Idaho has ¾ Republicans, so there would be no more calls. Again, I thought we were done: they are a solid opponent and getting their feet to move is difficult.

But Wayne Hoffman then inspired me. He had opposed the insurance exchange and declared he would never get health insurance since he considered the individual mandate to buy health insurance in the Affordable Care Act unconstitutional. I respected his stance. So I asked him in a meeting room if he now had insurance. His boss stood behind him and grinned, “Oh, we think he is too valuable to not be insured. We got him insured.” Wayne was a bit chagrined but said; yes indeed he did have health insurance now. I had considered his stance quite principled. If more of us took such principled stands, maybe this country would be better off.

So I decided to forgo my taxpayer paid health insurance. Martha (my wife) and I had purchased an individual high deductible (HSA) policy after I quit the group I was in back in 2007 and before being elected. It had been expensive. But I believe in the high deductible model and had been frustrated that the state did not offer an HSA compatible plan for state employees. We were one of only about a dozen state employees who took the high deductible plan; the cost was about the same for the regular deductible or the high deductible, but we chose it on principle. And now, after discussing it with Martha, on principle, I chose to give up my taxpayer paid state health insurance. If the legislature was not willing to consider getting 78,000 Idahoans health insurance at no cost to the taxpayer, why should I take the taxpayers money for me and my wife? It was a risk, I admit, but when you are trying to move a solidly planted body, risks are in order. To this day I am uninsured.

The end of the session saw some machinations. Many Republicans were very uncomfortable with the stance they had taken. I sensed they were willing to consider moving. There was more public comment, but I really don’t know what the Republican Central Committees in each county were talking about: that is where the true assessment of public opinion in this deeply red state occurs. But in the end, they stayed as firm and as solid as they were in the beginning.

So I am learning the skills of how to move this big body that I am firmly clasped to:

Know your facts

Know the ground

Always respect your opponent

Keep your balance

Don’t be afraid to push (or pull)

Timing is everything

Losing is when you learn the most.


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All Votes Count

Gotta Keep Getting Up if You Believe

Keep Getting Up from Cool Hand Luke


There was a recent Opinion Piece that got me thinking. In it, Idaho House Majority Party Assistant Leader Brent Crane was cited:

He offers caution to those who think Troy’s district would be better served by a Democrat, who would have no clout in the Legislature. A Democrat, he said, “can’t get a hearing on a bill if Republicans decide to block it. Caroline Troy could get a hearing on any bill she wants and she has direct access, whether it’s the governor, or if it’s House and Senate leadership. If there are things she needs to get done for her district, she can get things done.”

And then my opponent sent a letter to the local paper singing a similar tune. He states:

In Boise, Democratic votes count for nothing, as the Republican leadership typically requires a majority of the majority to get things passed.

I do not believe this majority party attitude serves our citizens. Are not we all sent to represent our constituents? Does the party affiliation of the representative mean those citizens are not represented in our political process? If so, then we have a significant problem.

Here was my response:

I welcome all to the political process. We need engaged citizens for this democracy to work. But to say, as my challenger did, that the solution to Idaho’s problems lies with simple party affiliation because only one party’s votes matter is counter to our democratic principles.

I believe every vote counts, here in our district or in the statehouse, I don’t care what your party. I vote for the ideas that will bring my state and my district prosperity, whether that means improving the income of Idahoans, their education or their health. If my vote falls in the minority, that doesn’t mean I was wrong or that my vote didn’t count. All votes count.

If the majority party believes my votes aren’t worth considering, I wonder who else they might dismiss. Do women’s votes count? How about the votes of ethnic or gay people? Dismissing the value of a person’s vote is insulting to our democracy. All votes matter.

Neither should we in representation dismiss any person. I always say, I get 51% of the votes but I represent 100% of the people. All people matter.

The old political one party dominance power game does not serve Idaho citizens. It’s time to play the game of ideas; I hope the voters agree.

But standing up to a bully, you can take a beating. But isn’t that what we need to do for this democracy to work?


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Tragedy and Public Policy


We can't measure rain that doesn't fall, but we sure ought to recognize a drought.

We can’t measure rain that doesn’t fall, but we sure ought to recognize a drought.

We had a hearing this last week to consider whether Idaho should change Medicaid eligibility so all folks in Idaho can have insurance coverage. This sometimes gets shortened to “Medicaid Expansion”. The hearing was short and mostly civil. One doctor from Eastern Idaho who had cared for a patient who died from severe asthma, an eminently treatable condition, suggested the Idaho legislature was “killing” Idaho citizens. I thought I would look into that.

Truly, we in Idaho government have made a choice not to consider this issue for the last three years. There have been two governor-appointed”work groups” who have recommended the governor “expand Medicaid” eligibility. He has chosen not to, and neither has the legislature discussed it. Have lots of people died from this inaction?

Well, we do know that by not acting in 2013 when we first could have, Idaho has lost hundreds of millions. But savings not received are like rain that didn’t fall; it’s hard to measure. But it shouldn’t take a farmer to know when you’re in a drought.

We do know that a positive decision by our legislature and governor did result in savings for the taxpayer. The Catastrophic Health Care Fund Board, (CAT Fund) of which I am a member, returned to the state general fund this session almost $30M almost all due to folks getting insurance through the state health insurance exchange. This positive choice has give us a measurable outcome.

So were lives lost that can be pinned on us legislators? Jenny’s story is compelling. Indeed, in my practice years ago I had a young man with severe asthma who would not come in because he had no insurance or money. This was way before the Affordable Care Act.  He struggled, always on the edge of a severe attack. I hospitalized him a couple times and saw him in the office whenever he came in, giving him as much free medicine as I could gather. But then, I signed his death certificate when he was found dead at home at the age of 30. If he’d had insurance would he be alive now? But the death averted by appropriate care is much like that rain that doesn’t fall; hard to know, hard to count. Still, we shouldn’t have our heads in the sand.


Every couple months we review applications from counties to the CAT Fund. This may come to 1200 a year. We got a smaller batch in December, only about 120, since the case numbers are trending down. I went through those cases this morning to look for deaths or diseases that might have been prevented. It’s very hard to tell from the sketchy details provided. Here’s my list from just a tenth of the annual cases:

64 year old male income $800/mo; Skin infection: tissue infection: DEATH

42 year old male income $1200/mo; multi organ failure…SURVIVED taxpayer cost: $36K

51 year old male income $200/mo; UTI: sepsis: DEATH  Taxpayer cost: $46K

32 year old male income $00/mo;   Tooth infection:neck infection: SURVIVED  cost: $22K

56 year old male income $730/mo; Heart disease:infection:DEATH    cost:$165K

38 year old male income $2300/mo; Stroke:DEATH         cost: $138K

56 year old female  income $00/mo; GI bleed; DEATH   cost $30K

62 year old male income $500/mo; pneumonia:cancer:DEATH    cost $15K


Honestly, I really don’t know if all these deaths could have been averted, I doubt anybody does. I did my best to communicate to the young man so long ago I would happily see him for no charge. I wanted him healthy and productive. But his disease, again one we usually can manage with medications and attention, proved fatal.

There are so many reasons why our current indigent and catastrophic system is wrong.  I will let you decide if it is killing people. But I can see a way out of this drought. And we are in one, can’t you see?


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Choose your Blandishment

“We look to the States to defend their prerogatives by adopting the simple expedient of not yielding to federal blandishments when they do not want to embrace federal policies as their own.”

Justice John Roberts in the Affordable Care Act Decision 2014


  1. a flattering or pleasing statement or action used to persuade someone gently to do something.
    We get Federal matching money for state programs all the time. And of course, federal requirements come with them. Some of these funds we here in Idaho welcome, some we don’t.
    This morning in JFAC I heard of Federal Grants administered by the Governors Office of Drug Policy. And there was a federal grant to the the Idaho State Police that required a supplemental adjustment.
    Here is the relationship in our Idaho budget of Federal to State and other sources:
    General Fund=Idaho Taxes Federal Funds= Blandishments

    General Fund=Idaho Taxes
    Federal Funds= Blandishments

    I have been working for years to get my legislative colleagues to consider the proposition to change eligibility, so 78,000 working poor Idahoans could get health insurance coverage. There has been little interest in this solution; I am struggling to understand why. I learned something from a colleague the other night and I am grateful.
    I sit on the CAT Board and review the 200-300 cases annually. People with no insurance suffer tragic health events, treatment is provided, they are found indigent by their county, liens are filed and bankruptcy ensured, and the Idaho taxpayer pays the hospitals.
    One solution would be to enroll these folks in insurance, as the individual mandate in the Affordable Care Act requires. But if someone earns less than 100% of the Federal Poverty level, they are not eligible to buy subsidized health insurance on Idaho’s state exchange. These are the “Gap” folks. Enrolling them in Medicaid would mean we would be accepting the federal rules if we took the federal money. Thirty one states have taken this step. Idaho has not.
    We have events some evenings and I try to attend when I can. At one two nights ago I was milling around and ran into a very conservative colleague. We share an interest in developing broadband access and he had just learned of a federally supported program that would build out fiber to under served areas at a 10:1 match. If Idaho invested $5M, the Feds would dump in $50M. He was ecstatic to learn about this. I shared his enthusiasm. We need rural broadband in this state.
    Then I pointed out, we could get rid of the CAT fund and improve Idaho health care funding with an even higher match rate (20:1).
    He frowned. He knew what I was referring to.”Oh there you go again with that liberal Obamacare stuff. We can’t take that money because the Feds are bankrupt.”
    “Just a minute,” I caught his gaze and said honestly,” You just enthusiastically endorsed accepting federal money for broadband development, but refused it for health care. Can you explain to me how you make this distinction? I want to know.”
    “That Medicaid expansion is never gonna happen, not here in Idaho, you gotta know that.” He was trying to laugh me off.
    I kept my gaze on him and my voice as kind as I could. I even touched his arm.”Look, I really just want to know how you make this decision. How do you decide when is it OK to take federal money, and when isn’t it?”
    He looked away but I could tell he was thinking.
    “I guess I just decide based on what’s important to me.”
    I thanked him for his honesty.
    Improving the health, the well being, the prosperity of Idaho is very important to me. I believe covering this “gap” population  with a health insurance plan would serve us all.
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Highways and Hybrids and the Man Behind the Tree




The Idaho legislature made a great leap in highway funding this last legislative session. It was years in the making with many failed attempts and some painful last minute compromises. But the years of discussion built an awareness of the need, so the compromises became tolerable. I have been hearing from many constituents about one of the compromises, fees on hybrid vehicles, and I am about convinced we ought to take another look. I take this opportunity to share some of my thinking and some background.

First, some may not agree that highways needed increased funding. These folks have let me know that any tax increase is unwelcome. But I was sure convinced of the need. Our governor went so far to commission a survey of likely voters. The results were pretty predictable; most agreed there was a need, few agreed on the right source of funding (toll roads were the least popular source).

So if we have a need and government is to help solve the problem, what principles do we use to frame the solution?

In my legislative discussions, mainly in the Senate, most I spoke with agreed we should keep highway revenue in a separate fund from the general fund, as it is now. The fear was that we might start taking money from schools for roads.  This goal got compromised, since we finally agreed to a “surplus eliminator” that took unbudgeted moneys at the end of the fiscal year and split it between roads and reserves.

The second principle proposed that revenues should be based on a “user fee” concept. That is, if you use the roads you should help pay for the roads. If you use the roads more, you should pay more.  Again, this got compromised, since we could not fully address the differences between what passenger vehicles and big trucks pay.

But the “user fee” concept fails if the only sources of revenue are fuel tax at the pump and registration fees. How does an electric car pay their fair share? So we calculated:

Electric cars might drive 10,000 miles a year. A comparable car might get 20 miles per gallon, thus buying 500 gallons per year and paying $160/ year in fuel taxes. An extra fee was added at the time of registration to electric cars of $140/ year as their fair share of a “user fee”.  I have heard little gripes about this.

But we added another fee for hybrids: $75/year. Nobody can tell me what calculations were used, or if there even were calculations. If you look at what MPG hybrids get, it’s all over the place. But I’m pretty sure they buy less gas per mile traveled than the Speaker’s ¾ ton pickup.

This has been the biggest complaint I have heard from constituents, and I think they have a good point. I served on the Interim Committee on Environment and Technology when we rewrote the Idaho Energy Plan in 2012 which contains:

It is Idaho policy to promote conservation and efficiency as a means of reducing the burden of transportation fuel expenditures, improving the reliability and cost of Idaho’s transportation fuel supply, and reducing transportation-related emissions.

The hybrid fee is in direct opposition to this stated policy.

The per gallon fuel tax at the pump is going to become an unfair “user fee” as alternative energy vehicles become more prevalent and fuel efficiency increases. There are other options. But for now,  we should eliminate the Hybrid vehicle fee.

There are many principles of taxation and fairness is one. But few agree on what seems fair. The one almost everyone agrees on when it comes to who should pay for a needed service goes like this:

Don’t tax him

Don’t tax me

Tax that guy behind the tree

Highways need funding and we should all be paying our fair share. Hybrids are paying more than theirs.

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Ghosts and Governing




We finished an extraordinary session last May to address some unfinished business. The legislature had adjourned and left a bill in committee that would have made enforcement of Idaho child support payments impossible. Some thought this was good but I heard from many in my district opposed to this unification of law. I listened, corresponded with most but came to realize in my mind that their fears were unfounded. In my first years of service in the Idaho Senate I had a similar experience with fears and voting.

Bills can be amended to make them “better”, but one’s vote comes down to “Yes” or “No”, so the ultimate decision must be based on what one believes is the best for Idaho and my constituents. My memory around this episode is not totally clear; I don’t remember the specific bill or issue, but I recall it came in the Senate Health and Welfare committee. That was a difficult year, my first; we had the Luna Laws, Medicaid cuts and lots to just figure out as a new legislator. I do remember the fatigue and effort of that time. The specific bill had a small impact, but I recall reading it and hearing the testimony, and deciding that no one else was seeing the unintended consequences I could see. I asked questions but got little comfort, then stated my case strongly. The bill passed through committee over my opposition. After we adjourned a committee member I trusted came up to me with a worried look. She leaned in and said, “Dan, what’s up? You don’t usually see ghosts.”

For that is what I was doing, seeing a ghost in the law. I had made the law into a phantom threat that I perceived as real. My fatigue, the legal language, my super-minority status all contributed. But now, five years later I can say that my fears were unfounded.

Fear can be a powerful political tool, but it should not be the signpost one uses to make decisions of governance. Fear can be exploited when one’s goal is power. But if the goal is to provide for the common good, fears must be addressed with reason and conscience, so that they are not the prominent issue when steering the ship of state.

The special session addressed some legislators and constituents fears, and the bill as amended passed; child support in Idaho is not at risk. But fear still prevents Idaho from addressing another big issue: health insurance for the working poor in Idaho. Our leaders have avoided the decision of whether low income folks should be enrolled in health insurance or instead receive bailouts from taxpayers after they have incurred catastrophic medical costs. There are fears about expanding Medicaid enrollment. There are fears about the Medicaid program. There are fears that the federal partnership is flawed.  All these are reasonable fears and need to be addressed. But we are not doing so. We are waiting. Fear is costing all of us. It’s past time to face up to our fears.


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2015 End of Session Letter online version

Session ends Soon (maybe)

The long first floor hallway in the Idaho Capitol

The long first floor hallway in the Idaho Capitol

I write to share and reflect on the work of the Idaho legislature this past session. This letter was mailed to many constituents, But I post it here with links, pictures, and graphs.


We start the session in the dark of January (second Monday) and we ended about 1:30AM Saturday, April 11th, a couple weeks past the spring equinox. Constituents should know what the legislature did as well as some of my own efforts and involvement. While it may not look like we are all working together, indeed we are. This system of government was not designed to maximize performance, instead to maximize representation. Many voices, many desires can make choosing a direction difficult.

There was clear direction on K-12 public education for the session. We have been through seven years of decreased funding and the demoralizing (now repealed) Luna Laws.

Last 10 years of Education Funding in Idaho

Last 10 years of Education Funding in Idaho


But our governor appointed a broad-based task force two years ago, and then he endorsed their recommendations. Top of the list was #1. Raise teacher pay, #2. Change HOW teachers are paid. We were able to accomplish this in the legislature this year with a Career Ladder bill and increased funding. Maintaining this commitment will require sustained effort. I challenge you to hold us to this commitment.

The second big need is road maintenance, but funding can be painful to talk about. Further, we haven’t had as much drama around highway funding, just a slowly building awareness of this need, so I was not surprised when we didn’t fully address this before we quit.  Since the whole legislature runs for election every two years, I doubt we will address this next year either, since it takes a special courage to stand before the voters and call for their taxes to go up. Estimates say we need $270M more a year just to maintain—not improve our roads; and this assumes a continued level of federal support. The bill we passed came in with a third of the needed support. But it will take a long, strong effort by our elected and industry leaders to move a plan forward. I am committed to this investment; let’s not wait for a crisis. Every year the hole gets bigger.

I had some specific efforts, but again, nobody gets anything done alone in this process. I am a member of the Joint Finance and Appropriations Committee (JFAC) and I am proud that we have controlled Medicaid and Health and Welfare spending for three years in a row now. This hasn’t always been the case (see graph below). I believe the efforts of the Department Director, the governor and the legislature all deserve credit. Nobody does this work alone.



Idaho must have a balanced budget; with limited revenue, if we spend more on healthcare, we spend less on schools and roads. JFAC improved funding for WWAMI medical students and of, course, improved K12 school funding. But let’s be honest; even with the increases for schools in the last 2 years, with student growth and inflation we still have not made up for the deep cuts in the previous years(see the graph above). I am worried about our long term commitment to education.

Finally, I tried to get all Idahoans eligible for health insurance coverage, but the majority party wouldn’t budge. Neither would they consider changing the Catastrophic Fund that pays for the uninsured. I sit on the Board that governs this $30M taxpayer funded program, and I believe lots of what we do is wasteful. But I could not get my suggestions heard. I guess the majority party likes things the way they are. I don’t; we need some changes.

Some other “projects” I worked on had to do with reducing prescription drug abuse. I have been working with all the professional boards and we are near an agreement. We also got a suicide prevention work group that will make recommendations to next years legislature. I worked with the funeral home directors to clarify a law. And I was able to successfully remove a law that made the practicing naturopaths in Idaho in violation of this statute. An interstate medical licensure compact was approved, as were the telehealth laws.

One of the greatest disappointments for me came on the last day of the session when a House committee blocked a law that insured reciprocity with other jurisdictions for the enforcement of child support. With this failure, Idaho will not be able to use the Federal system for tracking parents who owe child support, and we will lose money for Temporary Assistance to Needy Families, over all at least a $30M hit to Idaho children, maybe more.

Please email or call. If you want my newsletter,add a comment and request it, with your email address. I can only do this with your help; nobody does this work alone.




Idaho State Senator Dan J Schmidt, District 5 Latah and Benewah Counties


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Who’s your Senator?


I had lunch with the Idaho Medical Association Board members today. There are three doctors in the Idaho legislature and we always try to meet with this group when they are in Boise during the legislative session. We have been hearing from the IMA for years that they strongly favor the idea of medicaid expansion in this state. All three of us legislators (in both parties, mind you)agree that this makes sense. We know that getting folks insured saves lives and saves the taxpayer. I sense the IMA docs wonder why we three docs can’t convince 102 other legislators of this simple truth. I felt their frustration, so I shared some of my own. I asked them, “Who is your Senator?”

Think about it. Doctors should have, and do have a powerful voice. But it is most powerful when it is intimate. It is weakened when it is perceived as based on self interest; “We need more money”, “We need less regulations”. This plea will be met with a measured response, as it should. A legislators job is to serve the general welfare. But this message, that the folks we see day in and day out in our offices, that put off medical care because they are broke and working too hard but can’t qualify for the exchange but still have reasonable needs,these folks should have access to care.


And it isn’t a tough sell. It’s no harder than telling a young mom that her kid has eczema. We doctors have to offer such a message so it makes sense in a way she can understand. We have to make it a manageable problem. She doesn’t need to understand the immune system, just what to do every day and what to expect, and that her little treasure is not crippled or condemned. We doctors do this with our patients; if we want a voice in public policy we need to do this with our elected representatives. But first we have to know them.

I can go around the Capitol and buttonhole all my colleagues. I have. Their eyes glaze over. They are worried about their constituents back home, as they should be. So who is their doc back home? Does she support this issue? Can she have this conversation?

Politics is truly about intimate connections, as is medicine. I had the most impact on the patients I knew well and with whom I had a good relationship. Some I never got to stop smoking or check their blood sugars or lose weight. I always tried to maintain the relationship, and still let them know what I expected, that I respected and valued them. But some I did change. And I felt so good about such an effort. It really is about the relationship. So who is your Senator?

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