BOISE • The funding is still very much in the air, but Health and Welfare Director Dick Armstrong expects to be able to introduce legislation next week to implement a plan to extend primary care coverage to the uninsured.
Armstrong told the Senate Health and Welfare Committee on Tuesday that he has a draft bill. However, he said, the financing still needs to be worked out and is holding up its introduction. He told the Times-News he isn’t sure whether it will end up being one bill or broken into two separate ones that would go through the health and tax committees, respectively.
“It depends on the financial decisions on how to fund it,” he said. “We’re prepared to go either way.”
At the beginning of the session, Gov. C.L. “Butch” Otter proposed funding the program, which would connect uninsured adults in the “Medicaid gap” with primary care doctors through community health clinics, by shifting existing cigarette and tobacco tax monies that are paying for other programs now.
However, on Monday House Speaker Scott Bedke, R-Oakley, proposed paying for it with a combination of savings from the catastrophic health care program — spending has been dropping as more people sign up for health insurance — and money from the Millennium Fund, which is the state endowment fund that holds the money Idaho got from the settlement with the big tobacco companies in the 1990s.
House Health and Welfare Committee Chairman Fred Wood, R-Burley, backs Bedke’s idea. Wood said the tobacco/cigarette tax shift might not get through the House Revenue and Taxation Committee, and that there is a logical nexus between health care savings and health care funding.
“I applaud the Speaker for thinking outside the box,” Wood said.
Armstrong, too, said he is fine with that idea.
“Smoking is related to health care, and you’ve got to deal with it,” he said.
The Primary Care Access Program would cost an estimated $30 million yearly, the estimate based on spending $32 a month for each of the 78,000 people in the “Medicaid gap.” Those Idahoans don’t qualify for Medicaid but are too poor to qualify for tax credits to buy health insurance on the state exchange.
If the Legislature approves the program, it would start to serve people on Jan. 1, 2017. Armstrong said enrollees would be assigned to a primary care doctor and get a screening, after which they would receive occasional basic care if they’re healthy. People with more serious problems would meet with their doctors to develop self-care plans.
Also, Armstrong said, PCAP participants would get steeply discounted prescription drugs through the health clinics.
Armstrong went into some detail about people in the gap. Sixty-five percent of them live in a household where someone is working, 55 percent are women and 65 percent live in households with at least one child. One thing they have in common: They don’t receive any preventive care.
“These gap adults are only entering the system when they have an acute episode,” he said.
Using food stamp data, Armstrong pushed back on the idea that people who receive government benefits stay on them for life, and said he would expect some people who would be on PCAP to get off of it at some point. Out of the 575,000 people who have been on food stamps over the past six years, Armstrong estimates only 4 percent fall into the category of people who have been on the program long-term, and three-quarters moved on quickly.
Armstrong also said the program wouldn’t be an “entitlement.” The department will work with the money it’s given and provide what service it can with it, he said. If the department has to, Armstrong said, it would ration the money.
“This is all our money,” he said. “This is state of Idaho. We can drive the program as we see fit.”
By directing more money to the health clinics, Armstrong said PCAP could help them to hire more staff and expand their capacities.
“With this approach, we give them the opportunity, the clinics, to bring up their staffing levels to what is really going to be needed,” Armstrong said.
He estimated “CAT fund” spending could drop by a little less than half if PCAP is passed — using 2015 numbers and looking at the diagnosis codes, he estimated $16.8 million of the $36.3 million spent that year might not have been needed had PCAP been in place.
“We know there are some significant dollars being paid out today where we could make a difference,” he said. “So there’s great potential.”