Idaho Senate panel approves $10 million health gap bill

BOISE – A $10 million program designed to provide some health care services to a small portion of those who fall into Idaho’s health coverage gap cleared a Senate committee on Thursday and headed to the full Senate.

Amid concerns that it won’t do enough, Sen. Marv Hagedorn, R-Meridian, said, “I know it’s not enough. But we’ve just got to do something.”

Though more than two dozen people were signed up to testify on the bill, SB 1142, none was allowed to speak; by the time Senate Health and Welfare Chairman Lee Heider took up the bill, the last item on the agenda for an hour-long committee meeting, there was just 15 minutes left.

After Hagedorn presented his bill, which would tap tobacco settlement proceeds to pay for some primary care for uninsured people with chronic disease, and answered questions from the senators, the time was up.

Heider asked how many of those in the audience who had hoped to testify – including roughly two dozen doctors in white lab coats – supported sending the bill to the full Senate. None raised a hand. He asked how many opposed that, and at least a dozen and a half raised their hands.

“Ask them why,” someone muttered.

But the committee was ready to vote. At Hagedorn’s request, the bill was sent to the Senate’s amending order for changes; he said he has some details he wants to clarify.

Only Sen. Maryanne Jordan, D-Boise, voted no. “While I am grateful for the effort and the conversation on this issue, I think that this week we got answers on the long-awaited question of what will the federal proposal be,” she said. Fiscally, she said, “Medicaid expansion is clearly the best option for Idaho in some form.”

The same $10 million from Idaho’s tobacco settlement proceeds, with a 90 percent federal match, could provide $100 million in health care for uninsured Idahoans in the coverage gap, Jordan said, adding that option “is at least going to exist until 2020.”

The gap group consists of the 78,000 Idahoans who make too much to qualify for the state’s limited Medicaid program, but not enough to qualify for subsidized health insurance through the state insurance exchange. The gap emerged when Idaho chose not to accept federal funds to expand Medicaid, despite repeated recommendations from study groups convened by Gov. Butch Otter to do so.

“We learned a great deal of information, and we have a population that is need of assistance,” Hagedorn said, “and we can help change the market and bend the cost curve.”

Hagedorn said the $10 million figure in his bill is “not enough to cover the entire gap population. But we have people in the gap population who have chronic disease, that we really, really need to cover.”

When those patients can’t pay hospital bills or receive county indigent aid, he said, “We are paying for all of this care in one form or another. The objective here is to get this population healthy.”

His bill would enroll eligible uninsured people in a program that will “provide as much as we can in the form of pharmaceuticals and primary care.” Providers would contract with the state Department of Health and Welfare and negotiate a per-patient fee, rather than charge for visits or services; the providers’ task would be to “get them healthy and keep them healthy.”

Hagedorn said his proposal would expire in four years. “So it gives us four years to basically understand what we’ve got, if this program is effective.” He said the plan likely would need some “tweaks” each year, “all based on what the federal government’s going to do.”

But, he said, “This is foundational to what I believe the state needs to move to, in a value-based marketplace. We’ve always focused on insurance. … We have not focused on the delivery of health care.”

Jordan asked Hagedorn about the Legislature’s joint budget committee’s unanimous vote a day earlier to spend the same $10 million in tobacco settlement proceeds on something else – a slate of health-related program grants, plus funding for tobacco cessation and prevention programs through the state Department of Health and Welfare and public health districts.

Hagedorn acknowledged his bill would compete with that budget bill. “Until that bill has been passed by both houses, that funding is still available,” he said.

After the hearing, Hagedorn talked with a swarm of doctors and advocates in the Capitol hallway outside the meeting room. Many who attended the hearing wore stickers showing a stethoscope and the slogan, “Idaho needs a plan, not a delay.”

Hagedorn told the group, “Here’s our choice: We do nothing again, or we take a small step forward.”

When Dr. Magni Hamso of Terry Reilly Health Services told Hagedorn, “At least let’s put the Medicaid expansion bill on the table,” Hagedorn responded, “It’s not an option – there is not support to do that. I’m afraid … this is it.”

Lauren Necochea, director of Idaho Voices for Children, released a statement she had planned to present to the committee, saying in part, “This legislation does not go far enough. Until we leverage the dollars available for Idaho to expand coverage, we can’t solve a major problem in our state’s health care system.”

Hamso said, “Unfortunately, the vast majority of the folks in the gap are going to continue to suffer.”