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When Idaho's money talks, its goodbye

Marty Trillhaase
January 20, 2013
Lewiston Tribune

Usually a bright bunch of people, the number crunchers on Idaho's legislative budget committee watched nearly $30 million go up in smoke without so much as a whimper.

The occasion was Bonneville County Commissioner Roger Christensen's annual presentation to that panel. Along with state Rep. John Rusche, D-Lewiston, Christensen serves on a board that sees to it that hospitals and health care providers get paid when their patients lack the means.

It's an open-ended entitlement - and the costs keep rising.

Under law, hospitals cannot turn away patients simply because they can't pay. And if the bill isn't paid, health care providers - under state law - can compel Idaho counties to ante up.

Twenty years ago, the expense of that commitment began to overwhelm individual counties. The state came to the rescue, creating a catastrophic health care fund to pay the big claims. Counties cover the first $11,000; the CAT fund is responsible for the rest.

Last year, the number of people seeking and getting help from the counties jumped to nearly 6,500 - up nearly 1,900. And 90 percent of those new cases were mentally ill people who may have turned to the county after the state cut back its mental health program.

Relying on your property taxes, counties spent about $28 million.

Relying on your sales and income taxes, the CAT fund shelled out another $27 million.

That total - $55 million - is 24 percent higher than it was just two years earlier.

Looking ahead to next year, Christensen says CAT will need about $38 million from the state - that's a modest increase when you consider the board initially figured it would need $42 million.

Factor in a 15 percent boost in the number of people approaching the counties for help - and a 7 percent rise in medical inflation - and it's reasonable to assume property taxpayers will be on the hook for nearly $35 million.

It gets worse.

Midway through the next budget year - on Dec. 31 - Obamacare kicks in. With it ends a temporary federal program securing medical insurance for people whose pre-existing health conditions blocked their access to coverage. CAT figured it was cheaper to buy that federally subsidized insurance for about 130 people. When that program ends, those patients return to CAT, driving up Idaho's annual expenditures by at least $6 million.

Also expiring is a mandated discount in what CAT reimburses hospitals and health care providers. There goes another $2 million.

As he was laying out those facts, you almost heard Christensen begging to be asked this question: Why would Idaho leaders pinch their local and state taxpayers when the federal government would pick up the tab?

Under Obamacare, Medicaid will offer coverage to low-income adults - CAT's clientele - for a bargain. For the first three years, the feds will pay 100 percent of the cost of extending Medicaid to an estimated 80,000 Idahoans - and never less than 90 percent thereafter.

And unlike CAT, Medicaid provides ongoing, preventive care. Not only is that more humane than waiting to treat someone's crisis in an emergency room, but it's likely to be cheaper.

Idaho can say no, but Seattle-based Milliman Partners told the state it stands to lose an estimated $26 million a year.

Even a dyed-in-the-wool Obamacare foe such as Arizona Gov. Jan Brewer says taking the federal Medicaid money is too good a deal to pass up.

But Idaho Gov. C.L. (Butch) Otter dawdles.

He wants another year to think about it - while you'll go on paying for the most expensive kind of medical treatment there is.

Not one member of the budget panel asked Christensen if that makes sense.

And if those legislators don't raise the issue, who will?

Originally posted at

The editorial posted here is provided by permission of its original publisher and does not necessarily reflect the views of Idaho Public Television.

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