I have received many inquiries concerning the Medicaid Gap population and asking to expand Medicaid. This is my take on basic issues.
- Medical costs have gone from 4 percent of the GDP in 1964 before Medicaid and Medicare began to 18 percent of the GDP today. Government spending has distorted the market place as it has taken over a larger share of the market. In short, medical spending as a percent of the GDP is at least twice to 4x what it should be.
- Medicaid and other federal poverty programs create benefits cliffs that encourage recipients to stay poor in order to maintain eligibility. Federal poverty programs have not changed the percent of those in poverty.
- Medicaid and other federal poverty programs are funded by running continual deficits placing a debt on unborn generations. Our grandchildren are being required to pay for our current expenses.
I simply cannot expand failed federal programs. So what is to be done?
It was suggested that Idaho try to reform the Medicaid program by creating a state-run, state-financed medical program for the Medicaid Gap that did three things:
- First, focus on primary care rather than hospitalization like Medicaid does.
- Build community supports and community networks using Community Health Centers
- Help the Medicaid gap population pass through poverty as quickly as possible so that they can help pull the wagon rather than make the wagon more comfortable to ride in.
So what happened? The Idaho House struggled with these issues all session and eventually sent a bill to the Senate. The House version provided $5 million to Community Health Centers and set up a mechanism to continue the discussion. The Senate amended the bill asking Director Armstrong to begin the process of getting a waiver from the federal government to reform Medicaid.
Many conservative members of the House and the Idaho Freedom Foundation said this was a backdoor expansion of Medicaid and had it killed. So what will happen?
The issue is still before us. We will either expand the old Medicaid system or we will try to reform Medicaid. I will continue to work to reform the Medicaid system by focusing on primary care, building community supports, and help the poor pass through poverty as quickly as possible. It seems to me that if we are ever to reform federal poverty programs; we would have to do these three things. Why not start in Idaho next session?
Conservatives have to wrestle with that fact that the big-government poverty programs coming out of Washington D.C. will not be reformed by simply voting ‘no’ to every proposal that does not pass the purity test of traditional conservative thought. Will conservatives in Idaho engage and offer win-win solutions? I hope so.
I completely agree with you on this thanks for stickling to your guns.
So 78,000 Idahoan have no affordable health care insurance. Some that feel they need to pay are spending over 25% of their disposable income on insurance. The legislature did nothing to assist them but could put 2m dollars in the governors slush fund (Constitutional Defence) I would urge a special session to fix this problem
Health insurance is not health care. People pay thousands of dollars for insurance and THEN pay additional money for co-pays and deductibles. The insurance companies are laughing all the way to the bank. People could afford alot more health care if they were not required to purchase health insurance and could use those funds to pay out of pocket expenses. I strongly advocate health savings accounts plus catastrophic coverage. The entire chiropractic market in my county has shifted to cash pay (no insurance) – and I give my business to the practitioner who does the best job for the least amount of money – that’s called free enterprise. The same would work if doctors did cash pay only and cut out the middleman expenses of billing specialists.
I agree that the state has limited abilities to solve problems induced by federal action. Unfortunately the most important fix “Help the Medicaid gap population pass through poverty as quickly as possible so that they can help pull the wagon rather than make the wagon more comfortable to ride in.” is one of the hardest to fix. We have vast numbers of families in chaos because of divorce and substance abuse and it is difficult for government at any level to fix this.
The same people who voted against raising the minimum wage are the ones who claim to want to get people out of poverty. We wouldn’t last a month living on minimum wage. The State legislature wants to keep people in poverty so they don’t have to pay higher wages. I know how it works. Do you really think people can buy health insurance on minimum wage? You threw the 80,000 Idahoans who fall in the gap under the bus.
Entry level jobs were never intended to support families. They are meant to give work experience and pay to assist while obtaining higher training and qualifications sufficient to provide for self and family. Increasing minimum wage destroys small business, which is the backbone of our economy, and it harms peoples’ efforts to improve themselves.
Those of us pulling the wagon agree, we need more pulling. The current system is broken and gives no incentive to those in it to want to better themselves and their children. It is destroying the moral fabric of our society by rewarding idillness, which in turn breeds crime. A continual cycle that must be broken.
There is a solution, that is for those in the system to learn the value of work and the rewards that only those who earn their bread know.
The CCCs of yesterday did much for our country, without them we might be speaking Japanese or German right now.
The problem of high medical costs was in part an unintended consequence of companies thinking they would do themselves a favor and their employees by offering to pay medical insurance.
They essentially removed competition from the industry in that the consumer no longer was motivated to comparison shop for medical services or insurance.
So, now, lacking competitive forces, we have out-of-sight high prices as you indicate.
I will ask Wayne Hoffman why he fought an Idaho solution. They absolute key is to help folks become self-sufficient earning enough to pay for insurance as just one household expense.
Perhaps the key will be for the Idaho state government to offer DPC to state employees and encourage licensed insurers to offer a wrap around policy.
This will free up over a $1M of state expense providing funds for a state funded gap solution.
We don’t need permission (a waiver) from the f.g. to do ANYTHING! We just need to establish IDAHO policy and forget about the bribes of imaginary “money” from washington.
I believe charity is not the proper role of ANY form of government. But I can see it will be hard to convince people who believe the government has a big pile of money of which they ought to get their share.
Sheila Ford
Endeavor to Persevere!
297-11:20
What or rather who is considered in poverty? Are these new people, illegals, refugees? See what Maine has done to combat their high poverty pay-outs. A lot of money was saved by implementing some common sense guidelines ..
I agree there should be guidelines for who receives health care assistance. I would also look at the health/wellness guidelines of Medishare. If the individual isn’t attempting to take care of his own health by not smoking, drinking, using drugs, eating a healthy diet, etc., why should the tax payers pour money into health interventions that patch up the effects of a broken lifestyle? I agree with another comment that no benefits (other than perhaps a one-time drug rehab program) should be provided to a person who cannot pass drug screening. I do not think our tax dollars should pay for illegal or legal immigrants’ health care. We should only be admitting immigrants to this country who are capable of being self-supporting.
Thanks for your clarity. A huge part of this problem is the 100+ welfare programs that require having children out of wedlock in order to access the funds. A couple of years ago it was reported that we are now at a rate of 41% of our children nationally being born to a single parent, and I have read that 90% of these are born into poverty, aka welfare. That has to have a huge impact on the disappearing middle class. Many are living as families but are remaining unmarried in order to obtain these funds, which are simply being added to our out-of-sight debt load. Yes, we must have limits on the available of these ‘assistance programs’. They are causing tremendous harm to people, and especially children who are not encouraged to excel and develop their natural abilities for their own sense of accomplishment and independence. This is also heavily impacting adoptions.
Medicare Part D has to have had a major impact on pharmaceuticals. Because the fed has involved itself so heavily in health care, taking on a tremendous amount of responsibility for our health care, the cost of prescriptions has skyrocketed, primarily in the U.S. Pharmaceutical companies are free to charge as much as they want. David Walker, former U.S. Comptroller General has been warning for years of the tremendous debt for pharmaceuticals alone, at that time $16 trillion and growing fantastically.
There are many unintended consequences for our supposed generosity. Thank you for your efforts to reign it in for the great State of Idaho.
The problem is real but has been enhanced by let’s just do something for the poor people in trouble and then worry about how we are going to pay for it. I appreciate your strength and resolve to stand up and say wait a minute and take a look at what is causing this problem. We have way to many people in so called leadership positions with the backbone of a night crawler. We can all agree that a person that is sick needs to be treated and put back on a healthy track to be able to pull on the wagon.
It only makes sense that taking care of one’s own health is a place to start such as the primary health locations but it will never work when we have a system that just allows people to walk in and get everything for free. If they have to come up with a co-pay of some kind, either community service, cash or something similar to help them to make better decisions.
I once observed a lady with two children and on TITLE 19, living with a fellow that was working. She would not get married because she would lose that program. Her daughter got a splinter under her fingernail one afternoon and the mother waited till after her boyfriend came home to take the girl to get medical help. By this time all doctor’s offices were closed so she went to the emergency room of the hospital. A call to the emergency room at that time was $550.00 to walk in. An office call to a doctor was about $50.00 to $60.00 and a pair of tweezers would have ran close to a dollar. There was no problem though, because the TITLE 19 covered it either way.
In addition, I am not in favor of supporting drug and alcohol habits through giving free medical and welfare. It is only fair to consider 1) drug testing for access to both and if they are addicted and cannot commit to a treatment program and get to where they can contribute to pulling the wagon they are not worthy of the investment. 2) are they legal in the country? If not, they get the very minimum for medical treatment to save life and absolutely no welfare unless it is in the form of a one way bus ticket. Yes that is a strong approach and will probably raise the hair on the back of Dan’s neck but it is his type of stinking thinking that has led to this situation. There are too many people today that live for what they can get for free and do not want to better themselves or improve their life style by working for it. That is displayed best in the stinking thinking to raise the minimum wage (which is meant for entry level jobs such as kids in high school and just getting out to have a place to start). What is the level of responsibility portrayed by a person that has a job flipping burgers, getting married and starting a family and then screaming HELP ME, I don’t have any money? I need my wages raised up to support my family. With that type of mentality, you will never be able to raise the minimum wage high enough to take care of such an individual.
Stay the course: Cut the medical and welfare for the resettled, illegals, and continuing addicts. Charge a proportionate fee or work detail for a copay on medical calls. Require a drug test for access to both medical and welfare recipients along with a work regiment. Offer successful treatment on a one time basis to addicts to become eligible. When things are not so comfortable, people tend to use their heads to make it more comfortable
One solution is to find medical practitioners and facilities that are willing to offer pro bono primary care services for health, vision, and dental care and possibly prescription medicines and eye glasses. These pro bono services could be restricted to children, the long-term disabled, and senior adults in poverty. Other adults (of working age!) should have to make a minimal (perhaps $20?) co-pay for these providers’ services. They can at least perform some useful work at the provider’s office in return for the benefit they received (shovel snow!). Perhaps the state could pay the malpractice insurance costs of these citizen-servants in return. Local communities could form charitable pass-through organizations which seek sponsors to cover costs for more expensive medical procedures, such as non-elective surgeries. This already takes place in Idaho communities which hold fundraisers to help families pay for unexpected medical costs.
This approach would shift the health care of the poor from government-sponsored “charity” via forced taxation to true (voluntary) charitable service. Think back to how communities and medical practitioners provided health care to the poor before the advent of Medicaid and Medicare…
And tax credits.
More right wing junk thought. Every other western country pays about half of their gdp on health care than we do. Everyone is covered. And they live longer. They dont have these insurance companies. All of the hospitals do not have to have all of the latest eqipment as they are more organized. There is no delay in going to the doctor because of high deductbles. The CEOs of hospitals are not making 10 million dollars a year. The so called shortages are because you have to travel further for specialized services and if they wanted them they could finance them through tax debates, that is a nice trade off compared to thousnds of dollars in monthly premiums. No other country in the world wants a health care system like ours.