The Idaho’s Weather in the Health Care Storm


It’s cold here on the Palouse, lots of snow on the ground and near zero temperatures. But hot politics continues with a new Congress and Chief Executive vowing to “replace and repeal” the ACA. Health care policy has always been one of my interests, so I am very thankful we are finally talking about the difficult decisions that lie ahead. I welcome it. I can’t wait to dig into the details. I’m not afraid of the devil there.

I first got elected to the Idaho legislature in 2010, the year the Affordable Care Act was enacted. It was deeply unpopular in this deeply Republican state. I was cautioned to not talk about healthcare with voters when door knocking, the subject was so toxic. It struck me as such political posturing for the entire Republican congress to vote against a plan that had so many features of a Senate bill introduced and cosponsored by many Republicans seven years earlier. Indeed, a template for the ACA was the conservative Heritage Foundation’s plan for state exchanges, though they roundly disavow the similarity now. That posture I believe has harmed our republic.

The ugliest fight in the Idaho Senate during my six years, worse than the Luna Laws in 2011, was the debate in 2013 about whether Idaho should have a state or a federal health insurance exchange. There were references to the Holocaust. We established a state exchange and we’ve seen record enrollments.  Idahoans, despite their hate of “Obamacare” like having affordable health insurance. Who wouldn’t?

But the “repeal and replace” flurry in D.C. threatens the affordability Idahoans have embraced. 85% of the Idaho exchange enrollees qualify for subsidies, funded by taxes on health insurance plans. This funding mechanism is at risk in the repeal proposals. Who would buy health insurance they cannot afford?

Health care in Idaho, despite our lack of physicians and rural and frontier demographics, is actually pretty cheap. One reason is we tax our citizens to pay for those who are uninsured through the county indigent and state catastrophic plans. This prevents a small shift of the cost of the uninsured onto the insured, but it is shifted directly onto the taxpayers. Further, we pay after the catastrophic care is given, like fixing a bridge after it collapses. I favor a maintenance plan.

Idaho had a High Risk Health insurance Pool for people denied health insurance for pre-existing conditions. It was established in 2000 (before the ACA) and has served over 10,000 enrollees. But enrollment plummeted with the ACA (can’t be denied for preexisting conditions) and now there are only a dozen or so folks still on the plan, but a $20M+ fund balance( in conservative Idaho). If the ACA is repealed as promised, I have heard that this will be a state solution that is revitalized. Here’s an analysis of why they won’t work.

Did the state marketplace (Your Health Idaho) work? Yes, it did. We have seen strong enrollment and strong insurance participation. The failure of this deeply Republican state to expand Medicaid eligibility has kept our uninsured rate high. And insurance premiums are still going up, especially for those in the individual marketplace of the exchanges. This is directly related to health care costs climbing faster than inflation, and the risks the insurers feel in these uncertain markets. Throw in the Trump card and I can understand the insurers trembling. Idaho will feel this.

Bottom line is Idaho is well positioned to do the right thing, thanks to DHW Director Dick Armstrong and the new Dept. of Insurance Director Dean Cameron. Both understand the landscape. Dick has seen the need for payment reform and he understands the value of primary care. Idaho has invested in a Patient Centered Medical Home, but it will take strong leadership to carry this across, and Dick has announced he is retiring in June. Best wishes. Too bad for the rest of us, there is a lot left to do.





About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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