I learned about politics and civility my first year in the Idaho legislature. If one doesn’t pay attention it can seem brutal.
The state and the nation were facing the 2010 downturn, so budget cuts were proposed to Medicaid. It was a 60 page bill I needed to study; the new text was underlined and the deleted text crossed out, but I read it all, for they included each section of the law that was to be changed. I found language in an unchanged section that seemed to be giving a special exemption. When I asked about this I saw ears prick up.
As the downturn approached a couple years before, almost all the hospitals in the state had agreed to an “assessment”, that is, the hospitals agreed to pay back to the state of Idaho 10% of their Medicaid receipts and these would then be used to match federal dollars. Idaho gets from the feds $3 for every dollar it spends, so this was a way for hospitals to send off 10% and get more back. It’s a win-win unless you are looking at the US Treasury deficit. But the language in the bill seemed to carve out special hospitals from the assessment. Who were these special hospitals?
It turned out they were private, for profit hospitals, mostly doing specialty care. There were just five in the state that so qualified. When they bargained to be excluded from the assessment they claimed they got very few Medicaid dollars, thus should be excluded. I asked just how much money these 5 hospitals had gotten the year before from Medicaid. It turned out to be about $25M.
I asked around amongst my Senate colleagues if they would object to removing this exemption. My chairman said she’d have no objection. I asked the senators who had a hospital in their district. None warned me off. But I waited. Late in the session the chairman came up to me and asked if I wanted to make a change in that law. “You have done the research, why don’t you run this?” I agreed.
She called the hearing and I presented the bill to the Senate Health and Welfare Committee, where I was a member. The Department of Health and Welfare was there to support me, since I didn’t really know all the details of how this funding scheme worked. The committee voted unanimously to send the bill to the full Senate.
The day before I was to present the bill to the full Senate the chairman approached me and said there was a problem. “We have to bring this back to committee.” Why? “It seems there are some people who want to testify on this.” I knew.
The hearing the next day had no representatives from the Department of Health and Welfare to support me. And there were three men in suits in the back of the room. I presented the bill again to the very same committee that had voted unanimously for it a few days before. One of the suits came up to testify. “We just don’t think this assessment should apply to us.” When the bill came up again for a vote, my Democratic colleague moved that it be approved. There was no second. He leaned into me and said, “You can second it!”
I did not pause but whispered back, “Why would I want to do that?” It died for lack of a second.
I got in the elevator with a senior senator on my committee to return to floor debate. “That was a wise thing you did there, not seconding that motion.” Why? “Well, putting colleagues in the position to be on record can make for real enemies. You did the right thing.”
I don’t really know if I did. I didn’t pick a fight. I knew where the cards were in this hand, and I was going to lose. But sometimes, a fight is worth it. It wasn’t that day for me.