Governor Otter, with the help of the Director of the Idaho Health and Welfare Department, has developed a proposal to provide primary care to many in the Medicaid Gap. The ‘gap’ population is adults that do not qualify for Medicaid nor do they qualify for ObamaCare subsidies because they earn less than 100 percent of the federal poverty limit. There are about 78,000 people in the ‘gap’ in Idaho.
The State of Idaho would pay $32 per month to primary care providers such as community health clinics or rural health clinics to provide access to primary care. I am in support of this part of the proposal.
One of the reasons that the American health system is so expensive (about twice as expensive as any other nation on the planet as measured as a percent of the Gross Domestic Product) is because our medical system pays for hospital care and undervalues the role of primary care. Over 80 percent of all medical needs can be met in a primary care provider’s office. Medicaid, Medicare, and commercial insurance pay for specialty doctors and hospital care while underpaying primary care.
The foundation of any medical system must be built upon quality, affordable, primary care. The Idaho Department of Health and Welfare (IDHW) conducted a two year study of 9,000 Medicaid patients. These patients were assigned to a primary care provider and given enhanced primary care. This required an added investment of $1.5 million. The return was $8 million in reduced hospitalization and other downstream costs. We know that enhanced primary care works.
While I support the primary care portion of the governor’s proposal, I am working to address another area of need at the same time. Remember, the proposal called PCAP, is funded with only state funds. This means that Idaho can write its own rules. The PCAP proposal would be one of the few social safety net programs in the nation not operating under federal rules and requirements. This would give us an opportunity to address some of the underlying issues with long-term poverty by providing life coaches.
Poverty has many causes. Poverty is living in the state of need or in a condition of scarcity for long periods of time. Continually living in scarcity creates a self-sustaining loop of negative reinforcing thoughts, attitudes, and experiences that creates a trap few are able to escape without assistance. Poverty does not indicate personal weakness; but, addressing poverty requires more than meeting material needs. Regaining a sense confidence and belief in one’s own ability are essential to helping a person reach true independence. Helping someone escape poverty and enter into a life of abundance requires addressing four areas of life:
- physical/material needs
- relational/social interactions
- emotional, mental, and physical health
- spiritual beliefs
Historically, Federal poverty programs focus almost exclusively on one area – physical/material needs. This focus on one area of need at the exclusion of the other three critical areas explains, in large part, the failure of America’s poverty programs.
Director Dick Armstrong has masterfully described the need, value, and positive potential of providing primary care to those in poverty who do not have regular access to medical care. I am in full support of this portion of his proposal (Primary Care Access Program or PCAP)
However, the proposal is incomplete without adding to it a life coach requirement which will begin to address the other three areas of need: physical, social, emotional, and spiritual. Without a life coach requirement, few individuals in need will move into a more fulfilling, abundant life.
In my mind, the primary reason for the PCAP proposal is not to provide primary care. The primary reason for the PCAP proposal is to link those in need with a life coach to deal with the other three areas of need. A life coach without primary care is incomplete while primary care without a life coach is also incomplete. We have the opportunity to link these two proposals together to meet a fuller range of needs of those in poverty at almost no extra cost.
Life coaches would be trained volunteers from the community. Life coaches do not provide advice; they ask questions. They provide encouragement. They help the person in poverty reestablish their own resources. Life coaches help in the process of moving the person in a mental state of need, scarcity thinking, and dependency to a state where they feel empowered with choices and potential. Life coaches help individuals rebuild resources in all four areas of life.
Just as Director Armstrong stated that “we know primary care works”. We also know that life coaching works. Love INC in Nampa has been helping hundreds of people over the last 16 years. Love INC is only one example of the power of life coaches. We have all benefited from informal life coaches.
The PCAP proposal seems to be moving through the legislative process and will probably be introduced in about 10 days.