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Posts published in “Day: November 22, 2018”

Rip off the bandaid

schmidt

I hear the Idaho Department of Health and Welfare wants to wait until January 2020 to start enrolling people in the newly expanded Medicaid eligibility passed under Proposition 2 this last election. I’m sorry, but this is a pressing need. You state workers will need to git ‘er done.

Here’s why. Idaho has a taxpayer funded system, conceived way back in territorial days to pay for folks who need medical care but can’t pay for it. This is the county indigent health care system. It seemed to work OK for maybe a hundred years, but then small counties realized they could be bankrupted by one premature baby. So, the state Catastrophic Fund was conceived and now any bill over $11,000 goes on to the state. These county property tax dollars come to approximately $25M for all the counties and another $25M in state income taxes.

This system has propped up our small (and big) hospitals for too long. It needs to go. The sooner we get Idahoans enrolled onto health insurance, the sooner we can put this 19th century health care payment system in the dust bin. Git ‘er done.

I have questioned our new governor’s backbone. But this is just ripping off a band aid. We can do this; c’mon Brad.

Sure, there will be work to do. Folks who are now on the exchange but who would newly be eligible for Medicaid will need to be transitioned. That’s work the DHW will need to do sooner or later. We have a good number on this. Maybe 12,000 Idahoans could be affected. But there is another troubling number.

As the County indigent and CAT Fund costs have risen in the last couple years (since Trump and the repeal of the individual mandate) we are finding that more and more folks who are getting Idaho taxpayer funded indigent payments for their health care emergencies would not have been eligible for Medicaid. They make enough to buy insurance on the exchange. They just have chosen not to. But then they fall off a ladder and we pay for it. OK, they will be bankrupt, liens filed, but why can’t we make them enroll in an affordable health insurance plan. Maybe some folks like being free riders.

In my second year of medical school my first daughter got very sick and needed a complicated and life-saving surgery. My student health insurance wouldn’t cover it because it was due to a congenital (preexisting) condition. But the hospital and the surgeon did that surgery and we never got a bill. We benefited from their charity and I am to this day thankful to the point of tears for their generosity. But it meant I rode the system for free. And I resent that.

We all need to pay a share for the care we get. Idaho’s current system does not encourage people to think ahead, consider that they are part of the greater good. Instead we are encouraging people to play roulette, or more likely, Russian roulette with their health and our tax dollars. We are encouraging people to try to see if they can get a free ride. This makes no sense.

C’mon Idaho, Git ‘er done.