Special Update: Medicaid Expansion Hearing
I attempted to attend the hearing of Senate Bill No. 1204 and Senate Bill No. 1205 in the Senate Health and Welfare Committee meeting on Tuesday afternoon. However, hundreds of other people had the same idea. There were so many people that only those who were testifying and a few others were allowed into the meeting room. Two other meeting rooms had to be opened as overflow rooms.
To begin the meeting, Chairman Lee Heider (R-Twin Falls) told the room, “We’re certainly happy that all of you have come today. We have two options. There’s one that I would like to pursue, and that is to have this be an informational hearing only. Let me explain why I feel that way.” He explained that Governor Otter and the Department of Health and Welfare have proposed the Primary Care Access Program to address the issue of Idahoans who fall into the insurance coverage gap. Chairman Heider acknowledged that the Medicaid expansion bills deal with the same population and if the legislators have to choose, it would place them in “an awkward situation as a committee, to vote against one of our colleagues or against [the governor]”. He expressed that the informational hearing will gather information but there wouldn’t be a motion on either of the bills. Chairman Heider assured the audience that the bill is not dead and remains in the “care” of Senator Schmidt.
Senator Dan Schmidt (D-Moscow) expressed his thanks for the discussion and told the committee that he’d like both SB 1204 and SB 1205 to be considered together. Senator Schmidt stated that his goal for the discussion was to have an “open and frank conversation”.
The committee heard testimony from Dr. Ted Epperly, president and CEO of the Family Medicine Residency of Idaho, first. Dr. Epperly, who worked on both of the Governor’s Medicaid redesign task forces, outlined the two bills. He expressed his hope that the committee will send SB 1205, the Healthy Idaho Plan, to the full Senate with do pass recommendation. Dr. Epperly stated,
“This plan represents three years of hard work by Idaho experts on the governor’s work group, and it represents a tremendous opportunity to save Idaho taxpayer dollars, by leveraging federal dollars back to the state, and eliminating wasteful county and state programs that would no longer be necessary, not to mention the greater reason to do this, which is saving and improving Idaho lives, of low income Idahoans who fall into the coverage gap, and because of this live sicker and die younger.”
Dr. Epperly emphasized that a “usual source of care,” and “some source of insurance coverage” drive better outcomes for patients. SB 1204 and SB 1205 would provide both of those things while PCAP would only provide the first but not the second. In addition, PCAP would not allow Idaho to eliminate the current state Catastrophic Care program and the county indigency program while both SB 1204 and SB 1205 would.
Dr. Kenneth Krell, director of critical care at Eastern Idaho Regional Medical Center in Idaho Falls, provided unsettling testimony to the committee. He spoke about the Idahoans who fall in the coverage gap and explicated, “I see those patients on a near-daily basis through the emergency room who present with end-stage disease,” he continued, “dying, often, because those disease processes are now at an end state and have resulted in organ failure that often results in death or really irreparable damage.” He discussed Jenny Steinke, a patient who died from asthma; Jenny’s case is what really “crystalized” the issue for him. Dr. Krell told the committee, “And I kept asking myself, how could this be? How could, in a state like Idaho where we care about each other, could I be seeing deaths and really damaging illness on a nearly daily basis as a result of failure to expand Medicaid that cost tangible lives? It’s difficult to understand.” He cited statistics from a study in the New England Journal that compared states who accepted Medicaid expansion with a neighboring state that hadn’t. The study found that the failure to expand Medicaid cost 19.7 lives per 100,000 population. When extrapolated, it adds up to about 324 lives a year, meaning nearly one patient dies per day in this state as a result of not having Medicaid expansion. Dr. Krell acknowledged that, “It’s been said that perhaps it’s an ideological difference, that we just don’t want to accept federal dollars. But if that were true, I don’t see that we would see many in the Legislature accepting federal dollars for federal farm subsidies.” He concluded, “That the Idaho Legislature is unfortunately responsible for those deaths. Our intransigence in failing to pass Medicaid expansion for the last three years has probably resulted in over 1,000 deaths in this state. Please help us. I would ask you to please stop the killing. Thank you.”
Boise Mayor David Bieter testified, “I think this is the most important public policy decision in the state of Idaho by far”. He clarified, “I think every Idahoan believes that when we see suffering, we have a moral obligation to do what we can to eliminate that”. Mayor Bieter told legislators, “This is something you can do now. I really urge you to pass this bill.”
Chairmen Heider asked if anyone had come to testify against the bills. Fred Birnbaum, from the Idaho Freedom Foundation, argued that he believes the savings are based on “thin air” and we don’t know what future congresses will do.
In support of the bills, Shelly Gluch shared a personal story. She told the committee that her family couldn’t afford their medical care. She said her husband is chronically ill; they owe $60,000 in medical debt and are “stuck tight in a terrible cycle”.
Jim Baugh, executive director of Disability Rights Idaho, addressed the committee in support of the legislation. He said, “The single most important thing you can do to fix Idaho’s very severely stressed mental health system would be to adopt one of these two programs. People with severe and persistent mental illness need more than primary care; they need specialty care, hospitalization, and they need coordinated care.”
Chairman Heider ended the hearing without any motion or vote as promised. He thankedSenator Schmidt for bringing, printing, and hearing the bills and also thanked the public for coming and listening to the information-gathering session. Senator Schmidt thanked the committee for their time and acknowledged that there were so many people at the hearing that, “You could fill a couple days with the testimony that is here to speak before you.”
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