Rep. John VanderWoude, R-Nampa, asked state Health & Welfare Director Dick Armstrong why the governor’s PCAP primary care proposal died last year. Amid some laughter – Armstrong was the plan’s chief architect and proponent – he told the Legislature’s joint interim working group on the state’s insurance coverage gap, “It didn’t do anything to solve the counties’ problems, it didn’t do anything to solve the hospitals’ problem with the uninsured, it didn’t do anything for the Idaho Medical Association.  In other words, a lot of the supporters that we had for Medicaid expansion looked at PCAP and said, you know that’s like kissing your sister, this is not good.”

Once the laughter died down, Armstrong continued: “It lacked the solutions of the underlying costs that everybody’s bearing, it just didn’t do that. I thought it was a good starting point that would get basic primary care to a lot of people, including some behavioral health, and that it would be very helpful. Clearly others saw it as not really solving the bigger problem, and therefore not that terribly interesting. And I think the other was there’s that $30 million price tag, and all of a sudden tax cuts and other things started showing up that were kind of competing for that money, and folks started falling off the interest.”

“When I talked about it last summer, and visited with 85 of the 105 legislators all over the state, it was dandy,” Armstrong said, “but you’ve got to put it in juxtaposition with everything else. ... It was a lot of money and there were other needs. … There wasn’t a choir behind the conductor.”

“I get it, I understand,” Armstrong said. “It doesn’t mean that I have any less interest in making sure that every citizen of Idaho has a primary care provider and continuity of care, because I think that’s the right way to deliver health care. But you’ve gotta get there all at once. It just ran out of interest at the end.”

Armstrong said his original vision for PCAP was that it would be a two-year program that after two years, would transition into full coverage for that population. “That was my idea; it wasn’t anybody else’s idea,” he said wryly. “It was never proposed to be an ultimate solution. It was a step toward an ultimate solution. … It really wouldn’t stand on its own, long-term.”