West of the Rotunda

The primary function of the Idaho legislature is to set the annual budget. Our dear representatives love to wax eloquent on policy issues, and that is well within their function. But this year the Idaho voters spoke up on a policy issue the legislature has avoided for six years, Medicaid Expansion, and the Idaho House of Representatives is holding the Idaho voters hostage, refusing to address the budget for what is now Idaho law.

Six budget bills were passed by the Idaho Senate weeks ago that funded Medicaid Expansion. For weeks now, House leadership has refused to bring them up for a vote. Instead they have passed a “sideboards” bill, sending it to the Senate despite overwhelming testimony in opposition. And realize, this “sideboards bill” will cost Idaho taxpayers millions more than the simple Medicaid Expansion bills sitting on the House calendar.

Further, House Republicans signaled to the Senate they wanted the “Gag the Voters” initiative-killing bill (SB1159) sent over so they can approve it. House Republicans are puckered up on the lemonade they are making from what they see as a real lemon; the voter passed Medicaid Expansion Initiative.

House Speaker Scott Bedke got hurt real bad in 2013, his first year as the leader, when he let the House vote on a state health insurance exchange. He thought he had the majority of his caucus in support, but two Republican House members switched their votes at the last minute and the only way the exchange bill passed the House was thanks to strong Democratic support. He has vowed to never let such a thing happen again. The only way a tough bill comes to the floor of the Idaho House is with Speaker Bedke’s approval and he will only allow such a vote if he knows he has the majority of his caucus on board. That’s the “Bedke Rule” and it sucks.

By holding the Medicaid Funding bills hostage Speaker Bedke is giving the already supermajority House Republicans (56) total power over the body. He is negating the votes of the super minority House Democrats (14). Bedke is letting partisan politics trump the will of the people and holding them hostage.

I understand the Idaho Republican Party feels stung by the people’s initiative. They took a strong official stance against Proposition Two, even though many of their fellow Republicans, including former Governor Otter endorsed and voted for it. It makes partisan sense for them to now remove the people’s power of the initiative as they are doing with the “Voter Gag” initiative killing bill SB1159. But if they were being honest they would just work to repeal the Constitutional power of the initiative, not make it impossible through a law.

The Idaho legislature has been on a power grab for years now. The recent Constitutional Amendment to enshrine administrative rules review took two tries and some substantial Farm Bureau funding to pass the second time. This was the legislature puffing its chest against the executive branch.

But now they want to exert their power over the people. It’s not the first time. Every time voters have passed an initiative the Republican-led legislature has voted to make the initiative process further from the reach of the voters. In 1997, after the term limits initiative the legislature raised the bar. That was declared unconstitutional, so they quietly repealed the statute. But when the LUNA Laws were repealed by referendum, the Republican legislature reinstated the higher bar requirements, essentially ignoring the judicial branch. Now they want the initiative process beyond reach, securing their power in what is constitutionally designed to be a balanced system.

Speaker Bedke’s refusal to vote on the appropriations bills sitting on his calendar for the last two weeks is further bullying of the public he and his fellow Republican legislators are sworn to serve. This is not leadership, it is tyranny. Good people must resist when they see tyranny, especially in those they elect.

We elect our representatives. They are our voice in making the laws that govern us. Why do they need our input except at the ballot box every two years? What purpose does this public testimony on proposed legislation serve? If we do not have the backbone to hold them to account come election, then why should they listen in their deliberations?

It was almost relieving to see ten-term, 20-year State Senator Lodge acknowledge this last week. As Chairman of the Senate State Affairs committee she had a roomful of people who had come from far and wide to speak on SB 1159, changes to the Idaho initiative process. She let the three who wanted to speak in favor and then four of the 100+ who were opposed speak, then wanted to call for a vote. In her defense she said, “All the rest are opposed.” So, it’s like she knew what the committee was going to hear and didn’t see the purpose. After all, they are our elected representatives. Let them get on with it.

There was another time I have seen such an overt sham of public testimony. In my first term in the State Senate, 2011 Tom Luna, newly reelected Republican Superintendent of Public Instruction proposed his LUNA Laws. He had not mentioned them on the stump, campaigning just months before. But here he had a new legislature and what he considered to be a mandate, so he proposed his new laws; funding technology over teachers in the classroom. Public testimony ran for days, 95/5 opposed. But the laws passed. Then came the referenda and the laws were repealed at the next state-wide election 2 years later by an overwhelming 70/30 vote.

But here’s the thing: every legislator who voted for those laws was reelected.

Figure it out voters. I applaud that you might use the referendum process to rebuke your legislators for passing stupid laws. I acknowledge your wisdom when you want to initiate action like Medicaid Expansion because your elected legislators have ignored a problem with an easy fix. But I am amazed at the insanity of reelecting the same people to represent us, when we disagree with their decisions. Shame on us.

Idaho’s citizen Legislators, one Senator and two Representatives each serve districts of approximately 40,000 people. It is estimated that people can only closely know approximately 150 people. That means, for each of us to know our representatives in the legislature well, we have to make a big effort; have a cup of coffee, go to a town hall, make time for a meeting, or read their newsletters.

When I was in the Senate I sent out a weekly newsletter that approximately 1500 people read. If they were all talking to 150 different people, I would have been reelected easily. But I came to believe all these people knew and talked to each other. We are talking to the people who agree with us. Can we change this?

Who are these elected officials who represent us talking to? Where are they getting input? First, I would hope it’s from the elected officials in their district: the county commissioners, the city councilors, the highway district commissioners, the school board members.

Can this be dismissed to partisan affiliation? If so, we all should be questioning that insanity. But it may be true. I have heard a legislator say he met with his party central committee before each legislative session to consider legislation. Welcome to the echo chamber.

Don’t expect your passionate testimony to persuade the citizen legislators you have elected. It may be heartfelt and in fact, it may represent the sentiments of many of your fellow voters. But it is much more powerful to elect people who actually do represent your values. Share your values.

While the legislature struggles with modifying Medicaid Expansion, costing more, getting less insured, Governor Brad Little on the campaign trail was beating a different drum. He was looking beyond the twisted shorts condition of legislative Republicans who fought Proposition 2; he can see the bigger picture. Health insurance for those beyond Idaho’s exchange, Your Health Idaho, are getting squeezed out of health care insurance.

To be eligible for participation in the exchange you have to make between 100%-400% of the federal poverty level. Medicaid expansion addresses those below 138% FPL.

If you are a 60-year-old and you can participate on the YHI exchange and you make $45K per year, you might only have to pay 3% of your income for health insurance since you get subsidies. But if you make more than the 400% upper limit to participate in YHI, say up to $50K, you wouldn’t be eligible for exchange subsidies and the cost might jump to 32% of your income. This is called the health insurance “subsidy cliff”. Many Idahoans are standing on it. That’s me folks. And it’s steep. Why would I pay a fifth to a third of my income for something I might not use? I’d be a fool. Most Idahoans aren’t.

This is where the growing numbers for Idaho’s Catastrophic Health Plan are coming from. There is “the gap” population, the 70,000 below the 100% limit for enrollment on YHI, who will now be covered by expanded Medicaid; they won’t be the uninsured anymore. But those above 400% are going to or have dropped health insurance because they aren’t fools. Brad pointed this out whenever he could. I didn’t hear his solution.

The trouble with Idaho’s indigent program is, we take your assets if you can’t pay your medical bills. The really low-income folks, those below 100% often had few assets. But I imagine those making $50K have some tools, a work truck, maybe a back hoe the county can file a lien on. There goes their health and their means of income if they get unlucky and sick. Welcome to Idaho and medical bankruptcy.

So, beyond Bernie’s “Medicare for All”, what can Idaho do about this? It’s a head scratcher. Brad keeps talking about the Idaho High Risk Pool model and it’s worth consideration. The HRP was developed 20 years ago by State Senator Dean Cameron (now Director of the Department of Insurance) for people with preexisting conditions who couldn’t get health insurance. It was funded by a tax on all other health insurances sold in the state. It worked well for the ten years before the ACA eliminated preexisting conditions as an exclusion, then the enrollment dwindled to double digits and the fund ballooned to $20M. Could such a plan work again?

Some states have tried it, the reinsurance model, but each has varying success based on how much cost they are willing to shift. That’s the key, the willingness to properly fund the investment.

It’s worth fixing this.  Most businesses in Idaho have less than 50 employees. There are many small shops or self-employed folks who drive this economy and need this support to make health insurance affordable.

A recent suggestion from the Trump administration was for states to apply for waivers to Medicaid to allow subsidies for those above 400%. Of course, for this to fit the budget neutral requirement, the subsidies for lower income folks would have to go down to pay for the higher income folks cost reductions. Isn’t that how it always goes?

Polls show most people are not happy with how health insurance works in this country. Why can’t Idaho take some time and effort and make this work for our citizens? It’s worth the effort.