Dec. 29--BOISE -- There's one big question hanging over a $30 million plan to extend health coverage in Idaho -- how to pay for it?
The original proposal to fund basic preventive health care for the uninsured was to raise cigarette taxes, but that probably wouldn't pass, several lawmakers have told the Times-News. Instead, the money would have to come from funds the state already has.
"I have been told that will be general fund, it will not be a tax of some kind, so it's got to work itself out," said Rep. Maxine Bell, R-Jerome, co-chairwoman of the Joint Finances Appropriation Committee.
Sen. Bert Brackett, a Republican from Rogerson, said there is widespread support for extending some health care coverage to people in the "coverage gap" -- he supports the idea himself -- but he isn't sure if there is support for raising cigarette taxes.
"It's easy to support something, but until you can pay for it, nothing's going to happen," he said.
An estimated 78,000 Idahoans don't qualify for Medicaid but are too poor to get tax credits to buy insurance on the state's exchange. This proposal, which comes from Department of Health and Welfare Director Dick Armstrong, would extend primary care coverage to these people using a "patient-centered medical home" model.
For some Democrats, the plan, which wouldn't cover many medical expenses such as prescriptions or hospitalizations, doesn't go far enough and is a poor substitute for coverage the uninsured could have had if the state had taken part in Medicaid expansion. Rep. Donna Pence, a Democrat from Gooding, said the bills that result from a lengthy hospitalization are what can end up bankrupting a family, and those won't be covered.
"I'm glad to see we'll get something for them but ... it falls way short of what we could have done had we accepted the Medicaid expansion," she said.
The proposal will have to go through the Health and Welfare committees, which are led by Magic Valley lawmakers Rep. Fred Wood, R-Burley and Sen. Lee Heider, R-Twin Falls, respectively.
"I don't yet have a feel for how that's going to play out," Wood said.
Heider and Wood both said that much will depend on what Gov. C.L. "Butch" Otter calls for in his State of the State address, which is scheduled for Monday, Jan. 11, the first day of the session. Otter's press office said Monday that he wouldn't have any comment until then.
Heider said some funding possibilities include taking the money from reserves or taking some from the state's Catastrophic Health Care Cost Program, commonly called the CAT fund. Lawmakers hope the fund would be used less if Armstrong's proposal passes. Heider said the money is going to be "one of the main stumbling blocks," but he thinks it could pass if that can be resolved.
"If we could fund it, I think it would fly right through," he said.
The Affordable Care Act originally required states to expand Medicaid to everyone at or below 138 percent of the poverty level, with the federal government picking up the whole bill for the first three years and gradually reducing the federal share to 90 percent after that, but the U.S. Supreme Court ruled in 2012 that it was up to the states whether to take part.
Since then, many Republican states, including Idaho, have declined to take part in the expansion, and how to cover people in the gap has been a subject of political debate. Lawmakers have cited worries about the cost and about the state being on the hook if the federal government doesn't keep its commitment to fund it. Several GOP lawmakers told the Times-News last week that there isn't any appetite for full Medicaid expansion this year, either.
Sen. Jim Patrick, R-Twin Falls, was unsure what he thinks of Armstrong's proposal, but he did say he has heard about other states that have tried similar solutions and didn't necessarily save money by doing so.
"You want to save money or help people, or do both," he said.
Rep. Steve Hartgen, R-Twin Falls, said the plan has some good aspects but "it doesn't solve the problem."
"I would need additional information, he said. "At this point, I don't lean in favor of it. I still don't think we've answered all the questions."
Hartgen said raising taxes to fund it is probably a nonstarter. He also favors some asset testing of people who want to take part in the program. Things such as a newer car, a snowmobile or boat or an expensive television should count against you when it comes to getting benefits, he said.
"They are indicators that you can afford to have health care if you choose to pay for it," he said.
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