State of the State Address

Governor C.L. ‘Butch’ Otter gives his State of the State Address Jan. 11 at the Idaho Capitol in Boise.

DREW NASH, TIMES-NEWS

Gov. C.L. “Butch” Otter sent out a strongly worded op-ed Wednesday afternoon blasting the critics of his proposal to extend primary-care coverage to the uninsured and defending it as the only politically viable option to give them some kind of coverage.

“That difficult but unassailable truth is occasionally referenced by commentators,” Otter wrote. “However, so far it has been quickly dismissed as an illegitimate and weak-willed excuse for advancing an admittedly limited public policy initiative. Like a horse that starves waiting for oats while grass grows thick all around, they couch the debate in absolute terms — short-circuiting constructive discussion with a false ‘either/or’ choice between expanding Medicaid and doing nothing at all.”

Obamacare originally envisioned extending Medicaid to all of the working poor, but it has been a state option since a 2012 U.S. Supreme Court ruling and most Republican states, including Idaho, have rejected the expansion. This means there are an estimated 78,000 Idahoans in the “Medicaid gap” where they don’t qualify for Medicaid but are too poor to qualify for tax credits to buy insurance on the state exchange.

Otter's “Primary Care Access Program” proposal would extend primary care coverage to the uninsured, but wouldn’t cover other medical expenses such as hospitalizations and prescriptions. It has run into criticism from both the left and the right, with Democrats calling it a poor substitute for Medicaid expansion and some more conservative folks, such as Idaho Freedom Foundation head Wayne Hoffman and Majority Leader Rep. Mike Moyle, R-Star, have concerns about the cost and about creating a new welfare program.

"If you support this new entitlement program, then you have to remember you're taking money away from stuff like roads and water," Moyle told the Associated Press Wednesday. "I haven't seen the bill, but why would I support an entitlement program?"

"Our public discussion must recognize that PCAP is not short for 'panacea,'" Otter wrote. "It is intended instead as a point of departure for a longer-term effort to improve access to primary and preventive healthcare, especially in our under-served rural communities."

Otter's full op-ed is below:

I’ve read and watched with interest in recent days as legislators, healthcare providers, community leaders, columnists, editorial boards and citizens have reacted to the Primary Care Access Plan that I unveiled January 7th.

Responses have run the gamut from “It’s not enough – just expand Medicaid” to “We shouldn’t do anything but focus on repealing Obamacare.”

Despite what seems to be an immutable impasse, it certainly is a conversation worth having, and I’m glad we are having it. But critics seem to be missing the point of the proposal that Director Dick Armstrong and his team at the Idaho Department of Health and Welfare crafted specifically for Idaho. The fact is that the PCAP option – or something very much like it – is all that we can reasonably hope to achieve right now in the context of Idaho’s political environment.

That difficult but unassailable truth is occasionally referenced by commentators. However, so far it has been quickly dismissed as an illegitimate and weak-willed excuse for advancing an admittedly limited public policy initiative. Like a horse that starves waiting for oats while grass grows thick all around, they couch the debate in absolute terms – short-circuiting constructive discussion with a false “either/or” choice between expanding Medicaid and doing nothing at all.

The latter position has carried the day so far, and I will stick to the commitment I made to legislative leadership in June 2010 not to act unilaterally on any Obamacare-related issue. Yet I believe it is my responsibility to build support for homegrown solutions – not government entitlements but rather the kind of cost-effective solutions that involve building public-private partnerships and which reflect the independent, self-reliant character of Idaho citizens.

Our public discussion must recognize that PCAP is not short for “panacea.” It is intended instead as a point of departure for a longer-term effort to improve access to primary and preventive healthcare, especially in our under-served rural communities. It’s based on a patient-centered “medical home” model focused on connecting patients with a healthcare provider who supervises their long-term primary and preventive care.

The need is undeniable. Approximately 78,000 people in Idaho fall into the “gap” – the working poor who do not qualify for Medicaid, people who fell through the Obamacare net. But rather than growing the entitlement culture, PCAP embodies goals and priorities – including personal responsibility – which we have been independently developing here in Idaho since I took office in 2007, pre-Obamacare.

Haven’t we gone long enough without addressing the issue?

The point of this column, and of my administration’s work during this legislative session, is to make it clear to everyone that PCAP is not the final word on providing Idaho citizens with the opportunities they need to keep themselves and their families healthy. But it could be a great start.

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