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Readers Comment: Approaching the gap: A medical student’s experience

As a fourth-year medical student from Idaho and a future family physician, I regularly care for uninsured patients living in the coverage gap. These folks make too much to qualify for Medicaid, but not enough to afford insurance through the Your Health Idaho exchange. Many of them are struggling to live making the minimum wage. Their compelling stories motivate me to advocate for access to affordable, effective health care for all. In addition, this issue will soon become personal when I turn 26 next month.

Thanks to a popular Affordable Care Act provision, I have been covered my parents’ health insurance throughout college and most of medical school, but that will soon end. Soon after my birthday I will become uninsured. It feels like being evicted from the health care system, which is rather ironic given my future profession.

As a full-time medical student, my net income is $0 per month. Like many of our peers, my wife and I depend on federal loans to pay for our education and living expenses. One might assume we would qualify for Medicaid or other subsidized coverage, but in Idaho, that assumption is false.

Since Idaho has not expanded Medicaid, I have nowhere to turn for affordable health insurance. According to, the most affordable option available to me is a $382 per month catastrophic plan. It includes a $7,000 deductible, a $35 co-pay for up to three primary care visits, and no pharmaceutical coverage until the deductible is met. This is minimal coverage at best; it’s tough to justify this cost when facing compounding 6 percent interest on every dollar I spend.

Last year, I went to the doctor once. Fortunately, I’m young and healthy. But what if I were born with type I diabetes and my life depended on daily insulin? How would I pay for that? More loans, I suppose.

For years, our Legislature has failed to close the Medicaid coverage gap, which has left the estimated 78,000 Idahoans who would gain coverage in limbo. Sadly, political divisions have obscured the real issue at hand – human lives. Expanding Medicaid under the ACA would have saved 76-179 lives annually and created roughly 15,000 jobs in Idaho. Instead, Idaho failed to act and lost approximately $184 million in savings. It’s unclear how these numbers would change under the recently released Republican plan, the American Health Care Act.

Many Idaho legislators have put this issue on hold again this year, waiting to see if Congress repeals the ACA. I have read the House Republican proposal and while it has many flaws, it does not repeal Medicaid expansion outright. In essence, it gives Idaho one last chance to expand. Under the proposal, significant federal funding is still available to expansion states through 2019, and at a lower rate afterward. We cannot continue tolerating inaction. If Idaho fails to expand Medicaid again that failure is on us, not Congress.

Other view: We are all conspiracy theorists

Talk to a supporter of President Donald Trump and, at some point in the conversation, you are likely to hear some version of this: “The mainstream media is fake news. They ignore all the good things Trump is doing because they hate him and wanted Hillary to win. That’s why they spend so much time on this ridiculous Russia story and not enough time investigating whether Trump Tower was actually wiretapped!”

Talk to an opponent of Trump and, at some point in the conversation, you are likely to hear some version of this: “Russia has something on Trump. Michael Flynn, Jeff Sessions, Paul Manafort, and the president’s own unwillingness to bad-mouth Vladimir Putin and Russia all make clear that he is being secretly controlled by a foreign power. He needs to be impeached!”

What those two views reflect is the fact that we live in “X-Files” time now. Conspiracy theories aren’t dismissed; instead, they’re taken as something close to fact. “Prove that the conspiracy theory is wrong!” is now our default position as a society.

Now, conspiracy theories have always been with us—there was a second shooter in the JFK assassination, 9/11 was an inside job, and so on and so forth—but they have almost always existed on the fringes of political dialogue. Not anymore. We are all conspiracy theorists.

Here’s what Paul Musgrave, an assistant professor at the University of Massachusetts in Amherst, wrote in a piece for The Washington Post last week:

“Less than two months into the administration, the danger is no longer that Trump will make conspiracy thinking mainstream. That has already come to pass. Conspiracy theories, rumor and outright lies now drive the news cycle. ... In the long term, the damage done to trust by the normalization of untruth may threaten the social contract on which democracy itself rests.”

Trump knows is that for many of the people who support him, the fact that he has not offered any actual evidence of alleged wiretapping is besides the point. Of course the evidence isn’t readily available—the political establishment is doing everything it can to cover it up and make Trump look bad! So severe is the distrust directed at the media that if the media says there is no factual basis for Trump’s claims, that functions for his supporters as a sort of testimonial that he must be right.

On the other side of the political spectrum, there is the growing sense among Democrats that Trump is, in some serious way, in hock to the Russian government. That Trump’s former national security adviser and current attorney general both misremembered conversations they had with Russian Ambassador Sergey Kislyak is taken as certain evidence of this fact. As is the fact that Trump refuses to issue a stern condemnation of Putin and Russia. Or call for an independent investigation into the ties between his campaign and Russia.

There is, without question, smoke as it relates to the Trump’s team ties to Russia. But some Democrats are acting as though the White House is on fire. It’s not. More smoke should mean a real investigation. But more smoke doesn’t guarantee a massive fire must be burning.

As always, conspiracy theories could be true! The most prominent example is the reporting the National Enquirer did in the 2008 presidential campaign about a child then-Sen. John Edwards (D) had fathered out of wedlock.

But for every one conspiracy theory that winds up being true, there are a thousand—or a million—that are totally without merit. That used to be a sentence that 98 percent of the population could agree on. No longer.

Our retreat into partisan camps, the rising dislike and distrust of “elites,” the surge in partisan media outlets and the collapse of trust in the mainstream media has created a toxic environment in which conspiracy theories not only can bloom but are nurtured.

Stapilus: Sometimes, the counsel helps

The Idaho House has changed a subtle piece of its procedure, with—as usually is the case—mixed effects. The good are a little more obvious; the bad brings to mind legislators, one in particular, from years past.

The change is something many people probably wouldn’t notice. (Hat tip to writer Wayne Hoffman for pointing it out.) It has to do with the way votes are tallied when members of the Idaho House choose “yea” or “nay” on the floor.

When a bill (or something else to be voted upon) comes up, House members hit a button indicating a yes or no vote. The result of that is shown on an electronic board, visible to all, showing how each legislator voted, green for yes and red for no. The totals for each also are shown. This much hasn’t changed.

What has is this: Until recently, the greens and reds showed up immediately when the legislator punched the button. They could then look at the board, see who was voting how, and whether the vote was passing or failing, and if they chose, could change their vote before the speaker announced he was “locking” the vote in place. Partway through this session, however, those votes began not to show up on the board until after the “locking” had taken place. Any legislator wanting to change a vote might still be able to, but only as a part of the record and only with permission.

Is this an improvement?

On balance, it probably is. As a reporter watching House vote tallies, I used to enjoy figuring out who was voting in response to who—who was voting for something because someone else supported it, or opposing for that same reason. Some votes might be cast one way if it was clear the measure was going to pass, or fail, by a big margin—so that an individual vote might change nothing—but another way if the vote was really needed in a close call. Doing away with some of that real time information might be beneficial; it puts some onus on each legislator to prepare a bit more in advance and not rely on signals from other legislators.

But there’s another side to it, too, brought to mind by the death of one of the best legislators I call recall at the Idaho Statehouse.

He was Mike Mitchell, a Democrat from Lewiston, a beer distributor who may have had a higher profile from his run for lieutenant governor, or work as a governor’s chief of staff, or work with various state agencies. But I recall him as one of those lawmakers whose skill set was almost perfectly matched to work in the legislature.

He was unusually well prepared, especially on the more technical work; he served on the budget-writing Joint Finance-Appropriations Committee, and despite being in the minority he had as much impact on the budget as the leading Republicans did. That extended to other areas too. He had extra help from college interns, who in contrast to many interns over the years got to work intensively on the details and politics of getting legislation passed. Not only Democrats but a lot of Republicans too paid Mitchell close attention when he had something to say. He was, as several people remarked after his death a week ago, a “legislator’s legislator.”

Some legislators are blowhards. Some throw their weight around. Some exploit personal connections. But some legislators, of both parties and various philosophical persuasions, are worth watching: Their vote for or against something may actually be a signal that there’s a layer to the issue at hand that isn’t immediately obvious, and maybe ought to be heeded.

Mike Mitchell reminded me of that when I heard of his passing. There is a personal level to what happens at a legislature, and sometimes that’s not all bad.

Letter: Cooperation needed on downtown parking

I always thought that if you had a business downtown, you were part of it. I am a little disturbed about the signs behind Christa's Dress Shop and to the side of Scooters. Scooters has been an upstanding establishment for several years now, and to see signs that says No Restaurant Parking, I cannot see anything wrong with using those parking spots after hours when the business that owns them are closed. Really people, working together makes a community. Every establishment should be included in all activities including parking!

Jackie Smith

Twin Falls