Idaho is advancing a non-Medicaid expansion plan to provider health “coverage” to its working poor.
The Idaho Reporter has the details:
Gov. Butch Otter’s administration formally introduced its health care plan Thursday morning, which a top official billed as an Idaho solution to insurance coverage gaps.
Idaho Department of Health and Welfare Director Dick Armstrong introduced the Otter bill, which would give basic medical care to 78,000 Idahoans who make too much for Medicaid and not enough to earn a tax credit on the state health insurance exchange….
The proposal would cost at least $20 million in 2017, and another $30 million in 2018 and each year beyond.
Otter’s proposal doesn’t cover prescription drugs, specialty care procedures or catastrophic medical emergencies. It would give enrollees access to preventative and routine medical care, which the state believes will cost about $32 per person per month.
When I first this in Twitter last night, I thought this would be the equivalent of 10% to 15% actuarial value benefit. However when I looked at some external data and thought about it some more, this is a 6% to 8% actuarial value benefit.
6% to 8% is better than 0% but it is vastly inferior to paying slightly more money (at most) to get 98% actuarial value coverage via Medicaid Expansion.
And this is a better Republican offer for how to get health care to the working poor than most out there where the answer is to encourage begging, charity or dying quickly in the corner.
Access to primary care is a good thing. It is the first step to a good medical system as this is where low level concerns can be stabilized, treated and if they are chronic conditions, managed so that they don’t become intermediate or high level concerns that cost a lot of money down the road and significantly impact the quality of life of the individual and their social network. However, even within that caveat, I am trying to figure out what the value proposition is for someone to go to a PCP for the first time in years as they can now afford it, get diagnosed with Type 2 diabetes and then be told that the recommended maintenance medication will cost them hundreds of dollars per year and that any complications are not treatable. Or the person who goes to their PCP and is attempting to get their asthma under control, their inhaler costs $150 every two months, and the nebulizer machine which allows to use the much cheaper liquid mist albuterol is still $50 and limits treatment to only places with power. Or the person who comes into the doctor’s office because there is a really nasty infection growing on their hand, and the cheap generic antibiotics at the grocery store pharmacy aren’t working because that infection is MRSA. That treatment is several tens of thousands of dollars in the best case and a million dollars in a worse case scenario.
It would be good to have access to primary care providers, but a PCP is limited to how much health improvement over the counterfactual of no PCP treatment case if the PCP can’t use most of the tools in the medical tool box appropriately and judiciously.
It’s not health maintenance, it’s health deferred maintenance.
I gather the lack of catastrophic coverage is because that once a marginally-poor person gets run over by a bus, he becomes a Full-Fledged Poor eligible for Medicaid?
I get that sociopaths behind the plan, but you’d think they’d at least be a little embarrassed about launching something so transparent.
@dr. bloor: well, they are poor so it probably only takes them a month or so to spend down all of their assets. Just make sure you’re too sick to work, ok?
@dr. bloor: Depends on how bad the bus ran him/her over.
If it just broke a couple of bones requiring surgery and rehab to get back to near normal daily living, the person is not Medicaid qualified under stingy Legacy rules. If the bus causes sufficient injury to permanently disable them, they’ll qualify.
But the diabetic who could reasonably control their blood sugar will only qualify once their sight starts failing and their peripheral circulation goes to shit so that they can not walk enough to work.
At that point the state of Idaho is paying ~40% of the costs of Legacy Medicaid to treat someone whose acute crisis could have been averted for $20 to $50 dollars a month in prescriptions.
Not if your goals are to hate Obama and punish losers.
So, they will cover the cost of the person finding out that they have a serious condition that will bankrupt them and their family if they choose to treat it, instead of dying in ignorance.
Yes, that seems to be about right……..the Rethugs will be able to say that they are reintroducing personal responsibility into health care.
Perhaps Doctors in Idaho should provide some training and instruction to these patients in mastering the art of effective production of GoFundMe pages?
@NorthLeft12: There have been breast cancer screening programs for uninsured women that provided free mammograms and…Not sure I’d want to know in that situation.
@Richard Mayhew: Penny wise and pound foolish. I have health insurance and can barely afford 2 of my meds as is
Good post. At least with the Idaho GOP you know where you stand. It’s still penny wise and pound foolish, but at least it’s a something we can assess ind mock as opposed to the illusion proposed by the GOP in congress
I keep wondering why the people who propose such things don’t get shot.
“Otter’s proposal doesn’t cover prescription drugs, specialty care procedures or catastrophic medical emergencies.”
So it’s pretty much useless then. Prescription drugs and emergency treatment make up a considerable bulk of healthcare costs so Otter’s proposal doesn’t amount to much. I guess saying it’s better than nothing is faint praise.
I normally really enjoy Mayhew’s posts, but in this particular case I feel like it’s burying the lede: the governor of Idaho is an adult who inexplicably allows himself to be known as Butch Otter.
I mean, it’s not new information, but I break into a fit of giggles every time I see it. And since this proposal can’t possibly be a serious approach to reducing the cost of medical care, giggles seem to be an appropriate response.
Penny wise and pound foolish does comes to mind. Let’s face it, unless a Republican group benefits by the revenue stream (privatization) Republicans won’t support it. The viability figures don’t mean a thing to them.
I commend Idaho for poking it’s head out of the rabbit hole though.
Otherwise known as a simple appendectomy, or 10 stitches to the chin requiring a plastic surgeon’s touch, or polyp removal, or……
Pretty much walking through the doors of the ER automatically sets you back at least a $1K.
Idaho once. She left me when I stopped paying.
Also. “The Otter Bill”? So this one is more unusual than the previous one? I sea otter’s point, tho; time to get all 4 of his state’s homeless minorities some health care. Key word: some.
Deferred maintenance is the hallmark of the modern Republican, which is a hell of thing for folks who call themselves conservatives. We’ve become so inured to this type of bullshit, we cease to see how truly Orwellian it is. This is like saying giving your kid a bus ticket is sending her to college.
Republicans seem determined to believe that medicine still works the way they’ve seen it in old Andy Hardy movies.
Trot off to the drugstore, young man, and put that twenty five cent powder on my tab!
I know of one simple thing in medicine; an issue which lets you get some cheap antibiotics and get better. Everything else gets into money.
Will this plan get cleared by HHS?
I thought HHS still had to approve waivers to non-traditional Medicaid expansion.
I read this and immediately thought you might find this interesting.
Doctor owned Hospital chain goes BK because they didn’t take Medicare/Medicaid
Interestingly enough the headline in the physical newspaper blamed it on Obamacare, yet the article is the same as the online version.
@beltane: I was in that situation. And I chose to take the risk that what the suspicious shadow the mammogram detected wasn’t really anything rather than do follow up that may have confirmed cancer and rendered me unable to pay for treatment or ever get insurance thanks to the pre-existing condition. I got on an employer provided plan the next year, and it turned out to be nothing, but what a hellish choice to inflict on people. At least we don’t have pre-existing conditions as a disqualification for future insurance anymore.
@WereBear: Somewhere back in time, some genius decided to merge two things: the healing arts and the profit motive. We’ve been paying ever since.
@satby: A good friend of mine was in that situation as well. She had to live with a palpable lump in her breast for over a year until she landed a job that provided insurance. The lump turned out to be benign but the stress of living with it really took a toll on her.
Now that my husband’s employer has moved us to a plan that covers preventative care fully but has very high out-of-pocket costs for everything else, I am also in the “I don’t want to know” category. And we are the lucky ones.
@gene108: It’s not Medicaid therefore CMS/HHS does not have a say.
@Germy: That has always been the case (see Temple offerings and sacrifices — that meat was not tossed over the side, the priests/healers ate well and more recently, you could get surgery and a hair cut from the same person)
@Richard Mayhew: Weren’t surgery and medicine considered two distinct professions until the 19th century, with medicine being the more prestigious of the two.
@Richard Mayhew: Hence the barber pole, red and white. Blood!
Why did this guy’s parents name him after a gay personals ad?
I live in Idaho (beautiful Boise, a somewhat purple dot in a red state). My wife & I have good coverage through my employer though its an high deductible plan. And it’s better than our piano teacher friend. He’s in the Medicaid gap. He has some back issues and is probably pre-diabetic. I was hoping this would be something worthwhile so he could at least see a doctor.
My wife has wondered if we could adopt him.
I’d prefer that we find some way to provide everyone with some minimum but effective amount of coverage. I hate that the canards about PERSONAL RESPONSIBILITY and NO SLUT PILLS are big barriers. I just hate the way we’re stumbling about and not coming up a system to provide everyone with some protection.
Villago Delenda Est
So, basically, the plan is to continue to fuck the poor.
Try being in this mind-boggling ironic situation:
– My wife is an ob-gyn physician, my late father was an ob-gyn physician, my older daughter is an anesthesiologist (in another distant state), my younger daughter is a R.N. nurse at a high-quality local hospital. So I am about as much a life-long “insider” to the medical system as it’s possible for a lay person not employed within it to be.
Before I became eligible for and switched over to Medicare last year (via a BCBS Medicare PPO supplement policy), my health insurance for years was via my wife’s practice group’s BCBS policy, which had a $5k annual deductible before most benefits kicked in. This caused me to postpone getting a colonoscopy for years past when I should have done, as well as postponing visiting an orthopedist about my gradually but progressively deteriorating osteo-arthritic right knee. I had even dragged for years about getting a basic physical check-up.
I’ve now done all three within the past 6 months, as well as had right knee joint replacement surgery 18 days ago (my ortho said I was astonishingly high-functioning for someone who’s knee joint was as much of a wreck as mine was – he said if I’d postponed doing that another year, the ligaments would likely have become distorted by the stress of differential wear (my tibia had actually become misaligned by 5 or so degrees outward) that the chances of a knee replacement working optimally well to my satisfaction as a physically active person would have been reduced. But with the 5k barrier, I would have probably kicked off taking care of the ortho visit (the ortho doc forced me to get a primary care checkup as a precondition for surgery).
YES we are fortunate that push come to shove, we could have afforded to eat the 5k expense for something really important without going on an austere cat-food no-fun financial diet. But even for folks in our position, 5K is still a significantly inhibiting factor that it causes even us to postpone preventative or curative medical stuff that really needed taking care of.
I’m glad to see someone eviscerate this “plan,” which is indeed awful.
But you do realize that the points made in the article are essentially the left criticism of the ACA? That at the bronze/silver levels it creates “insurance” that doesn’t cover anything serious without a deductible that’ll drive the beneficiary bankrupt, and thus is creating a regressive tax for coverage-not-treatment?
@satby: Yes, what a hideous situation and one that undermines our health no matter the outcome.
There’s an incredible book, How We Do Harm, by Dr. Otis Brawley. He delineates how the profit motive has absolutely pillaged our medical system.
One story I’ll never forget is the woman who had treatable breast cancer, but her job would not let her have the time off to get it treated. So she had insurance, but if she used it, she would lose the job and the insurance.
And so she resolved to hang in there long enough to get her kids out of the house.
She didn’t make it.
Villago Delenda Est
@WereBear: The profit motive as the be-all and end-all of all economic activity is something that Adam Smith would decry, were he around to be labeled as a communist by the Ferengi shit who are determined to make this planet uninhabitable in the name of short term profit.
@Tiercelet: There is a significant difference between 60% actuarial value coverage (Bronze) or 70% actuarial value coverage (Silver without cost sharing reduction subsidies) and 6% to 8%
And there is an even bigger difference between 6% to 8% AV coverage and 98% AV coverage that is a straight up Medicaid expansion.
For two people, one at 99.99 FPL and in the Medicaid gap and the other making $5 more per year at 100.0001% FPL, the difference is a 8% AV program for PCP care without prescription drugs and a 94% AV (Silver with CSR) comprehensive policy.
Silver with CSR declines noticeably in value at 200% FPL; and that is a population group that has a plausible chance of paying off a $4,500 deductible over a couple of years IF they get hit by a bus or a one time acute illness. It completely sucks for chronic conditions that require a continual stream of payments over many years (think diabetes)
Butch Otter sounds like the name of the villain in a children’s book…
they would rather people die so that they can make their political point. evil summabitches.