{"id":1449,"date":"2021-07-11T19:25:05","date_gmt":"2021-07-12T02:25:05","guid":{"rendered":"https:\/\/danschmidtforsenate.com\/blog\/?p=1449"},"modified":"2021-07-11T19:25:05","modified_gmt":"2021-07-12T02:25:05","slug":"idaho-laboratory","status":"publish","type":"post","link":"https:\/\/danschmidtforsenate.com\/blog\/?p=1449","title":{"rendered":"Idaho Laboratory"},"content":{"rendered":"\n
\"\"<\/a>
Louis Brandeis<\/figcaption><\/figure>\n\n\n\n

\u201c\u2026a single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.\u201d USSC Justice Brandeis<\/p>\n\n\n\n

Us dang Idaho citizens foisted Medicaid expansion on a reluctant legislature through the initiative, Proposition 2 in 2018. For a couple years now all they have been doing is pounding sand. First, they tried adding on every limit the Freedom Foundation told them to: work requirements, private option, sorting out the sick. This was after the Freedom Foundation\u2019s lawsuit to overturn the initiative failed. Now, in a supreme act of petulant pouting, legislators have tried to virtually eliminate the tool we used, the Constitutional initiative process.<\/p>\n\n\n\n

Instead of reading the landscape and trying to figure out the best process, they want to turn the clock back. I suggest, forget trying to invent the flux capacitor; get to work on some real public policy experiments.<\/p>\n\n\n\n

They have the data. You do too<\/a>. Thanks to the Idaho Department of Health and Welfare sharing public information (which legislators are reluctant to do<\/a>), we can study the information and make some suggestions for some courageous experiments.<\/p>\n\n\n\n

Do you get a sense these legislators are more interested in keeping their seats than serving the citizens? But that\u2019s a different rant.<\/p>\n\n\n\n

After just six months of Medicaid expansion enrollment data, a study was presented to the Idaho legislature about what was happening. There was no legislation, no policy reactions, no meaningful comments after last December\u2019s presentation.<\/p>\n\n\n\n

So, let\u2019s look at the information ourselves.<\/p>\n\n\n\n

First, enrollment is a bit ahead of the expected numbers. We did have a significant economic downturn what with the Covid shutdowns and bump in unemployment. I don\u2019t find those numbers alarming. Honestly, I can\u2019t believe the economic gurus sitting on a $800M 2020 surplus in Boise are much alarmed either. But the hand wringing will continue about paying for 10% of the costs. Remember, Idaho pays 10% of expansion costs, the federal government prints the dollars for the 90%.<\/p>\n\n\n\n

One of the beauties of Medicaid is that the data about where the money goes is open for us to scrutinize. Somebody should: maybe our elected representatives?<\/p>\n\n\n\n

No, they want to fight off the CRT boogeyman, so I guess it\u2019s up to us.<\/p>\n\n\n\n

Let\u2019s drill down.<\/p>\n\n\n\n

The first six-month data shows the Per Member Per Month costs. PMPM is a useful number to understand. If you pay $300\/month for your health insurance and your employer pays $400 and you don\u2019t pay any copays or deductibles, your PMPM is $700. Add in all the annual copays\/ deductibles\/ out of pocket costs and divide by 12 and then you have the full PMPM.<\/p>\n\n\n\n

The Idaho Medicaid Expansion population in that first 6 months sat at $517 PMPM.<\/p>\n\n\n\n

In Idaho, Medicare <\/em>PMPM (remember, older, more expensive) is $707PMPM.<\/p>\n\n\n\n

Where did that big chunk of money go? The folks who studied that population for the first six months noticed some interesting things.<\/p>\n\n\n\n

Idaho Medicaid Expansion enrollees had spinal fusions at a rate 5X that of comparable expansion states. Their length of stay in the hospital was shorter, but the greater number added $6.50 to the PMPM.<\/p>\n\n\n\n

100,000 Medicaid Expansion enrollees x 12 months x $6.50 = $7.8M<\/p>\n\n\n\n

Expansion enrollees got general physical exams from specialists, not their primary care physicians. This added about $.80 PMPM, or $960,000.<\/p>\n\n\n\n

They looked at knee and shoulder arthroscopic surgeries ($1.80 PMPM), hip replacements ($2.67 PMPM), and a lot of others. Each penny adds up.<\/p>\n\n\n\n

If you want to control health care costs you have to find the tools and be willing to use them. The variability and waste<\/a> in health care spending has long been known. Let\u2019s get to work on it. Be courageous.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201c\u2026a single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.\u201d USSC Justice Brandeis Us dang Idaho citizens foisted Medicaid expansion on a … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[19],"_links":{"self":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1449"}],"collection":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1449"}],"version-history":[{"count":1,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1449\/revisions"}],"predecessor-version":[{"id":1451,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1449\/revisions\/1451"}],"wp:attachment":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1449"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1449"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}