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Posts published in “Day: June 29, 2023”


We citizens have decided it is best to let our legislature call itself into session whenever they can get enough to sign on. So be such folly. But while our august lawmaking body does their potato field, or insurance sales work and makes no laws, not in session, some small legislative groups labor on. For there is work to do. This is a wiser strategy.

The House and Senate Health and Welfare Committee chairs, during this last legislative session agreed to sponsor a resolution to call an interim committee together to consider whether it would be wise to move Idaho Medicaid toward managed care. They are thus meeting. I’ll bet you missed it. There were no headlines. But the meeting is available for your review if you have the hour to spare for the download.

I took that time.

They aren’t dummies, this group. That is deeply reassuring to this skeptic.

Just what the heck is “managed care”? Since in modern parlance, we can put a fancy name on anything we want to sell, the buyer should always beware. Make no mistake, we taxpayers are the buyer. Just what are they selling?

And I found the legislative group to share my skepticism. When someone goes into this sort of inquiry with a passionate bias, I expect somebody somewhere to make a lot of taxpayer profit. I did not see such bias as I watched the 4-hour download.

Managed care does not rile up folks like critical race theory does. Or indeed like “death panels” did. Health care policy puts people to sleep. It’s not like you are protecting your children from groomers or predators. The sad truth is, if you want to make some progress on public policy, saving the taxpayer a dime, you need to focus on some details. And that is boring, slogging, sit in the chair and pay-attention work. And that’s what this group seems ready to do. I was a bit thrilled. Are you?

Maybe instead you want to bring your semiauto to a pizza parlor to save the children. It seems that’s the prevalent mood out there. So, I want to speak up about the courage to pay attention to the details. Nobody brandished a weapon. But we are talking big money.

For contracting with a firm to “manage care” for Idaho Medicaid mean we, the Idaho taxpayers, are entering into a $3B dollar contract. Puleeze, notice the “B”. We might spend a million on a bridge, or a new school, but BILLIONS? Who is going to ride herd on such a contract?

It was telling that the spokesperson to the Department of Administration early on in the hearing admitted, meekly, that indeed it would require another full-time hire.

So, we’re going to hire one more person to make sure they don’t rob us blind?

Idaho has, since the Republicans have taken over, continually hummed the off-tune hymn “Business is Better than Government”.

Can I remind you of these mistakes? I know, all you guys with the Trump flags on your ¾ ton pickups will consider this a waste of time, but here I go.

Idaho tried privatizing our prisons. After lots of evidence for failures, a Republican governor who had advocated for this, abandoned his run.

Then there was the IEN fiasco, for broadband in schools.

Then the Luna Laws.

Wherever there is a lot of money in Idaho government, there are contractors out there willing to do our work for us. For a slim(?) share of the (?)profit.

Forty states have Medicaid managed care contracts. We have a lot to learn from them.

Heck, Idaho even has tried managed care with our Medicaid mental health contract. We contracted managed outpatient care back in 2014.

What did other states learn from these efforts? What have we learned?

Our poorly paid interim legislators have some hard work to do.