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Columnists
COMMUNITY COLUMNIST
Brugger: Rural health care is in shambles. Here's how Idaho can fix it

A very real reason why rural voters are unimpressed by the Affordable Care Act is that, even with the ability to pay, they do not have trouble-free access to a doctor. If they have a good primary-care physician, they face extended travel and appointment delays when they need a specialist. Forget the scare tactics of the opponents of single-payer health care. In rural America, there is currently no choice of provider and lengthy delays for treatment.

This was brought home to me this weekend when I had the opportunity for discussion with relatives in Denver. We were gathered to discuss the health and care for our 81-year-old matriarch, and my niece said, “I don’t know what people in rural areas do. We have so many choices and can always find a doctor to see us right away even if it isn’t the first one we call. That isn’t available outside of a large city.”

What can Idaho do about this situation? Recognize that this condition requires state funding that is not currently available. Or, as I am not afraid of saying, raise taxes. The dilemma confronting rural health care requires money, and as Idaho already has demand for all current revenues, it requires new revenue.

The Community Health Centers in Idaho already contribute to better rural health. CHCs are federally subsidized clinics furnishing coordinated medical, dental, behavioral health and low-cost pharmacy care in rural areas and to people who pay their bills on a sliding scale determined by their total household income, as well as people who have insurance. Family Health Services in the Magic Valley and Fairfield currently has eight such clinics.

The main impediment to the increase of patients served as well as the number of these clinics is the number of providers who are available. Even the inducement of paying student loans is often not enough incentive to come to Idaho.

How can Idaho spend money that helps? The state can significantly fund larger numbers in the nurse practitioner and physician assistant programs offered by Idaho State University as well as the nursing programs offered by colleges like the College of Southern Idaho. The funding is about both space and instructor salary. Idaho institutions can find the students, but they cannot find the capacity to meet the demand.

Boise will soon host a private school that will turn out new doctors of osteopathy every year. The Legislature should offer student funding in exchange for a contract to practice in rural Idaho for multiple years. Our two major hospital systems already host intern programs, and their capacity to do more can certainly increase.

Idaho can provide money for mobile medicine. FHS already has a mobile dental bus. It is possible to put medical, behavioral health and pharmacy services in a bus that serves tiny towns on a regular basis. Telemedicine can provide specialized care, including routine surgery, if the infrastructure is in place.

We can, of course, wait for the federal government to “solve” this. Even if we join all the rural areas in the 50 states with this problem, I doubt that Idahoans would be thoroughly satisfied by the results. If we educate our people here, they can practice here. Money spent stays in our state generating more taxes. Better health care is an inducement to settle in smaller towns.

Expanding Medicaid is still necessary. However, one person who commented on a previous column said he didn’t want to compete with more people for the scarce medical resources. No matter what happens

in D.C., Idaho has a problem Idaho can fix. Funding better health care throughout the state isn’t sending tax money to bloated government entitlements. It is an investment which benefits every Idahoan and brings us solidly into the 21st century.


Columnists
OTHER VIEW
Other View: What Planned Parenthood offers

This appeared in Thursday’s Washington Post:

Of all the magical thinking that has gone into Republican proposals to replace Obamacare, none has been more fanciful than the argument accompanying efforts to defund Planned Parenthood. The yarn that has been spun is that other health-care providers would easily absorb the patients left adrift if Planned Parenthood could no longer receive Medicaid reimbursements. In truth, there is no way community health-care centers cited by Republicans as an alternative could fill the gap. In truth, millions of women would lose access to critical health care.

A succession of experts, including from the American Congress of Obstetricians and Gynecologists and the National Partnership for Women & Families, has consistently refuted claims that community health centers, which receive federal funds to provide health care to low-income people, would be able to pick up the slack if Planned Parenthood were cut off from Medicaid. Planned Parenthood offers high-quality health care, including birth-control services and cancer screenings, to more than 2.4 million Americans at 650 affiliated health centers every year.

The Washington Post’s Kim Soffen, using data from the Guttmacher Institute, detailed how federally qualified health centers, already struggling under their patient loads, would be overwhelmed with demand from new patients in need of services. Planned Parenthood, The Post reported, serves “one-third of all contraception clients among family-planning clinics nationwide” and in some states sees up to six times as many patients as the health centers do. Rural areas would be hit particularly hard, and the effects would be felt immediately. Unlike other parts of proposed GOP overhauls of the Affordable Care Act, there would be no delay in triggering the Planned Parenthood provision.

“Political convenience, not a viable policy proposal” was how Guttmacher characterized the argument that community health centers would become the main source of federally funded family planning. A further complication is that the community centers themselves face uncertainty if the Affordable Care Act is overhauled with the dramatic cuts to Medicaid that are envisioned in the Republican proposals.

The impulse to defund Planned Parenthood is grounded, illogically, in opposition to abortion. Set aside the fact that abortion is legal and constitutionally protected. More salient, perhaps, is the fact that federal law already bars the use of federal dollars for abortions except in rare cases. So what is gained by depriving poor and working women of the basic health services that Planned Parenthood provides—and that no one else can provide? Anyone voting to deprive Planned Parenthood of Medicaid reimbursements should have to answer that question.


Mailbag
Letter: CSI trustee race was just the beginning in movement against refugee center

Rick Martin is no politician. He hardly campaigned at all in his race for the College of Southern Idaho Board of Trustees. He's hardly known. Still he racked up 44.4 percent of the vote, and even beat Laird Stone, his opponent, in Jerome County with 51.01 percent of the vote. That's 37,120 votes, more than “a few.”

Those are the numbers, and it spells trouble for the CSI Refugee Center. The Refugee Center has far more people against it than they ever thought. It would have been good advice, as Times-News Editor Matt Christensen pointed out, for the CSI trustees to listen to the people who came to the first meeting at CSI with concerns. That’s what started all of this. No representation for people who had fundamental questions about national security.

Mr. Martin didn’t win, but it was an excellent start. I don’t believe the question with the CSI Refugee Center is settled. And NO, I’m not in Mr. Martin's camp, just an observer. And NO, I’m not a fan of the refugee program. Never have been. Mr. Martin exposed a very unpopular program here in the valley, and I thank him for it.

Danny Crafton

Hansen


Columnists
OTHER VIEW
Other View: Republicans out of options on health care

Senate Majority Leader Mitch McConnell’s new plan is to ask Republicans to suspend reality until after casting their vote: Regardless of what the bill actually says, it means whatever they want it to mean. To state the obvious, this is not exactly a strong position. Conservatives will believe they are being betrayed, while Republicans (and everyone else) who want to preserve Medicaid won’t believe the reassurances.

McConnell, whether his reputation as a master legislative technician is deserved or not, is no fool. He simply has only a few choices remaining at this point in the game. Playing pretend is one of the last tools left at his disposal.

The bottom line remains where it’s been since January: Very few congressional Republicans want to be responsible for the changes that repeal-and-replace would produce — including, of course, taking health insurance away from millions of Americans. Even fewer want to be responsible for killing the item at the top of the Republican rhetorical agenda since spring 2010. And at the same time, there’s a group of very conservative members who want to take advantage of a rare unified government opportunity to roll back major parts of the Great Society.

There’s just no way to square that circle.

And House Speaker Paul Ryan, for better or worse, has done an excellent job of boxing McConnell in. Ryan was able to get something through the House by basically using the same logic McConnell is attempting now: Secure the support of various factions by promising that their objections would be dealt with later on in the other chamber. That was sufficient for those who were unhappy with the House bill but didn’t want the blame for defeating it. And then Ryan has made it clear (or at least effectively bluffed) that the House will accept intact whatever the Senate will do, making it harder for McConnell to do the same thing — senators believe that anything that they pass will wind up as law, and they’ll be liable for the effects.

Republicans have become increasingly desperate over the last few months to find a way to fulfill their campaign pledge to repeal and replace Obamacare. But their streak of mistakes began years earlier. There were many, many off-ramps available since the Affordable Care Act was signed — well, really, since the original bill first hit Congress. Republicans had plenty of chances to either shift to “fixing” the health care system instead of claiming they were able to fully replace the status quo. Or they could have defined “repeal and replace” as something that they really could have accomplished. Or they simply could have declared victory and moved on to something that was more promising for them, such as taxes — in other words, they could have gone with a “pretend and rename” version of repeal and replace.

It’s still not clear what the fate of this legislation might be. The surface problem remains the same: It’s hard to satisfy the very conservative demands of Rand Paul, Mike Lee, and Ted Cruz without losing the votes of the least conservative Republican senators such as Dean Heller, Lisa Murkowski and Susan Collins — and vice versa.

But I think the underlying question remains a more basic one: Do Republicans really want to pass a bill? Not just if they’re willing to vote for it, but do they really care about getting this done?

If they do, it’s likely that compromises will eventually be found. If they either don’t want to pass anything or, more likely, just don’t feel all that strongly about it, then they probably won’t.

What goes into the answer to that question are several things. Basic political calculations — is it worse to break their promise on repealing Obamacare, and responsibility for managing a law they never supported in the first place — or is it worse to be stuck with responsibility for the replacement? Policy considerations — they may really care about the effects of the status quo compared to the replacement bill in their districts and across the nation. And who knows what other considerations any of the 52 Republicans might have.

It’s anyone’s guess what that adds up to. But I certainly don’t hear very much enthusiasm about the bill from any congressional Republicans so far. That might (might!) be the most important hint about what is about to happen.