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Healthcare delivery in Idaho: Eventually, system to make fiscal sense

Guest Opinion

The maze of healthcare delivery in Idaho may become even more complex this year.

A majority of states have expanded Medicaid per the Affordable Care Act (ACA) to fill gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. In Idaho, it’s estimated about 140,000 individuals would qualify and benefit greatly. Expanding Medicaid per the ACA in Idaho would save millions of dollars annually by providing a higher federal match percentage (90/10), obviate the need for 44 counties to levy property taxes to fund their respective “indigent” programs, and save millions more by scrapping the statewide “Catastrophic Fund.” Idaho County taxpayers alone would save about $400,000 per year and our three commissioners wouldn’t have to be judge and jury almost every week to determine who is and isn’t funded.

Governor Otter won’t recommend Medicaid expansion in 2016 as it’s a non-starter in the current legislature; however, his budget does include transferring $30M from cigarette tax collections to launch a Primary Care Access Program (PCAP). The idea is to connect uninsured Idaho adults living in poverty with a physician or mid-level provider to coordinate their primary and preventive care services. There are no federal rules or dollars associated with the PCAP; however, there are state rules and dollars that are apparently more palatable. Primary care providers who participate will be paid $32 per member/per month to follow a patient-centered medical home model, charge participants an income-based sliding fee scale, assess health status, design individual treatment plans, and submit aggregated utilization and outcome data to the Idaho Department of Health and Welfare.

At this point it appears the PCAP won’t cover inpatient or outpatient hospital care, ER services, specialty services, ambulatory surgery, rehab, vision, radiology, pharmaceuticals, lab testing, other key health care services. It has all the makings of a complex and frustrating new proposition for patients and providers. In any event, it’s a start! The PCAP discussion will certainly open the conversation for future side-by-side comparisons of the PCAP vs. ACA Medicaid expansion.

Eventually we’ll have a system that makes fiscal sense by getting more federal dollars, uses tobacco tax collections for population health purposes, abolishes the county and state indigent/catastrophic programs, and (most importantly) effectively provides comprehensive health coverage for all Idaho residents.


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