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Posts published in “Schmidt”

Medicaid expansion’s uncounted benefit

schmidt

When I served on the Governor’s first workgroup that studied and recommended Medicaid Expansion for the State of Idaho, I sat on the panel next to a former director of the Idaho Department of Corrections. I had previous experience working as a physician in the Idaho prisons and we had discussed this in the past.

After one long day of presentations from experts with graphs, tables, numbers and projections as we were getting up from our chairs to go he bent over and whispered to me, “I hate that Obamacare, but this Medicaid expansion would sure be a benefit for my guys.”

I nodded, but after he left I wondered if he meant by “my guys” the recently incarcerated and released, or the guards who work at the prison. Knowing the low pay for prison staff, he may have meant both.

The next day when the summary was being provided about the costs and benefits of Medicaid expansion, I asked the expert if they had figured in any savings from criminal justice costs. They said, no, such calculations would just be too hard to do. I argue they would be substantial. You can’t count what you don’t see.

People in custody (county jail or state prison) are not eligible for Medicaid health insurance to pay for their health care. That cost comes right out of the Idaho general fund. Right now, the charge for folks in prison is over $16/day, almost $6000 per prisoner per year; a total of $48M dollars a year we can’t spend on schools or roads.

My short time working as a doctor in the Idaho prison taught me a lot. I was expecting to see lots of healthy young men with a history of behavioral and substance issues. I was surprised how many middle aged and older inmates there were with chronic disease. Over 65% of the inmates were on chronic medications; many were on psychiatric meds. Imagine what happens to these folks when they are released to the community with no access to health care and a $6000/year health care habit. We are being stupid about how we treat people. Idaho pays 100% of their health care costs in prison, then because they are not eligible for health insurance in Idaho, we pay 0% when they are released. If we expanded Medicaid eligibility we would pay 10% of the costs. Seems a good investment to me.

Right now, the legislatures Justice Reinvestment Oversight Committee (JROC) is hearing testimony from “experts” as to why we need to spend $500M to build a new prison here in Idaho. That’s what the Board of Corrections has recommended. Prosecutors are saying, “It’s not our fault our prison population is exploding. We are just enforcing the laws you legislators write.”

The easiest, cheapest recommendation the JROC could make to the legislature and the governor, easier than sentencing reform, cheaper than building a new prison, would be to say what the former director said to me: “We hate that Obamacare, but expanding Medicaid would sure be a good thing for our people.”
 

Something for those in the gap

schmidt

Dear Brad,

I hear you say that you favor doing “something” for Idahoans in “The Gap”. These folks make less money than people who can go on the Idaho health insurance exchange (Your Health Idaho, YHI) so they can’t afford health insurance. You presided over the bitter debates in the Idaho Senate about establishing YHI. Governor Otter bravely fought for this and continues to support it; do you? You know the current system where we pay for the uninsured through catastrophic care, but then liens are filed and they are bankrupt. Some even die for postponing their care. It’s costing Idaho Counties tens of millions and The Idaho General Fund as much or more. I want to know your plan for getting health coverage for our working poor citizens, since you seem reluctant to support the Medicaid Expansion Initiative.

I know you know the numbers. You know how much Medicaid Expansion would mean to rural hospitals and clinics. So explain to me why more expensive half-measures like PCAP or this year’s double waiver plans make sense to you. You supported these plans, but you say you didn’t support the Medicaid Expansion Initiative, which covers more people and costs Idaho taxpayers less. You didn’t sign the petition.

I’ve read your support for returning to the High Risk Pool model, where we tax all health insurance premiums to pay for those who can’t get health insurance. Before the ACA when preexisting conditions were a reason to be denied health insurance, they seemed a reasonable solution. The goal was to get everybody covered by a health insurance plan, as it should be. Explain to me why this is a better option than Medicaid Expansion.

Maybe you aren’t willing to fight the well-funded and very vocal far-right Freedom Foundation who believes only “free market” health care solutions should be considered. That YHI fight in the legislature sure was bitter. But Idahoans flocked to the exchange to buy health insurance. And county indigent and state Catastrophic costs plummeted. It was a hard fight, but I think it was worth it.

Governor Otter has appointed at least three “advisory panels” on health care since 2007 and all have made recommendations to promote universal health insurance coverage in Idaho. He also had two “work groups” who recommended Medicaid coverage be expanded. So Governor Otter has had plenty of hand-picked groups give him advice neither he nor the legislature was willing to act on. Is this your plan too?

To be fair, Governor Otter has followed the advice of one group to promote medical education in Idaho. He supported it with budget recommendations. He also followed the advice to work on changing health care delivery through promoting the Primary Care Medical Home Model for Idaho. And Idaho is in the middle of rolling out a State Health Innovation Plan, designed to reform delivery and payment methods for the state. If “Medicaid is broken”, as I have heard in the Idaho statehouse, let’s work to fix it.

Director Cameron’s innovative suggestion to move high-cost patients with certain diagnoses onto Medicaid to lower private insurance costs shows Otter’s appointees can think outside the box.

It looks like Idaho could be poised for some dramatic and innovative health care changes. States could lead with health care innovation. I believe expanding Medicaid eligibility fits well with these. Why don’t you? Let me know.
 

Sign the petition

schmidt

When the Idaho House chose to not vote on Governor Otter’s “Dual Waiver” plan last week I was not surprised, nor were most Idaho voters. We have come to expect such inaction, such cowardice, such laziness from our elected officials. We forget, they reflect, not just represent us, the people.

We are truly cowards, you and me for not addressing this problem before us: how should health care be paid for? It’s complicated, I’ll admit. That might explain the laziness we have shown. Maybe, since most get their health insurance through their employer they don’t really have to worry too much about it much. That’s just another excuse for laziness. But do we aspire to be a lazy nation? Think about how employer based health insurance traps someone with a good idea or some initiative, but maybe a chronic health problem. Or how the brave young entrepreneur fears his wife might have their baby too early and his dreams are dashed with medical bankruptcy. Laziness and cowardice have trapped us. Don’t try to blame your elected representatives. We are the problem.

We want someone to offer a simple answer. I was intrigued by Director Cameron’s innovative idea to put expensive patients on a government health plan. It’s not a revolutionary idea, but it was brave to suggest. We should all have such courage to offer such ideas. But more, we need to listen to each other’s ideas and have conversations. Our leaders have not been good examples at this. But we can do it.

I have been engaged with a group of young activists working to put an initiative on the ballot that would enroll those below the poverty level who cannot now purchase health insurance on the exchange. It is a simple, cost effective plan to get more people enrolled in health insurance. It expands Medicaid eligibility. I am impressed with the broad support and the effort. I have had many good conversations as we ask for signatures. I know it will not be the final answer. But it’s a good start. Sign the petition.
There is much more work to do to make Idaho health care affordable and effective. It gets down to answering the question of how we should pay for healthcare.

Do Idaho lawmakers and voters really believe the Catastrophic and Indigent funds are an appropriate way to pay for health care? If so, then why don’t we just expand that system to cover all? Drop your insurance, pay for what you can and if you can’t afford it, you will be bailed out by taxpayers after the liens are filed and your bankruptcy ensured. This is health care terrorism sanctioned by the state. I hope you never have this experience. But it’s the current Idaho way.

Unfortunately, the CAT and indigent funds have made us a little too comfortable. These meager payments have supported small hospitals that are teetering. And we can pretend these unfortunate folks had some sin that made them deserve cancer or a mental illness or tragic accident.

We need to have the courage to build a system of health care funding that encourages responsible productive citizens. Getting everybody covered, doing away with indigent and catastrophic care is a great first step. Sign the petition.
 

Where’s the leverage?

schmidt

Idaho leaders are considering plans to carve up the health care market to save you money. You better be sure which side of the health and wealth teeter totter you fall on, because this could be great news for you or catastrophic. Blue Cross of Idaho is already on board. Should you be?

Do you know if you are going to be hit by a drunk driver? Will you have cancer next month? Or will your wife have a baby too early? I’m a doctor, I studied predisposing conditions, risks and genetics, and I can’t say I knew the answers to these questions. Sometimes I did, but it was usually long after any enrollment period. Insurance companies are multibillion dollar financial betting organizations; they have experts to answer these questions. And they have a bottom line to meet. I figure they know a good deal when they see one. They don’t want expensive patients, and you don’t want expensive patients in your insurance plan.

The fundamental premise of insurance is to pool risk. Before the Affordable Care Act, if insurance companies saw your risk as too great, they could refuse you; no more. They got more customers with the (now repealed) mandate to buy insurance, but they gave up denying folks with preexisting conditions.

The ACA tried to get people to be good shoppers; you would assess your risk, and then chose on the exchange from comparable plans that would suit your needs. It’s been pretty popular here in Idaho, with record enrollments, year after year. Before the ACA, if you wanted to shop for individual plans, it was worse than shopping for jeans that made you look good, with no changing room.

True, the ACA mandated there should be a minimum level of benefits, and limited the range of benefits (Gold, Silver, Lead), but this was to make the marketplace press the insurance companies to cut health care costs. They have barely made a dent, even though Medicare and Medicaid have been effective at containing costs in the last six years. They have leverage. Private insurers have not been able to leverage health care providers, or consumers (YOU) to decrease consumption, improve efficiency, and thus lower costs. So now the white knights arrive.

Cameron and Otter suggest more choice; more slices of the insurance pie will lower costs. Well, they will for you if you don’t get hit by a bus or get cancer and you have chosen the right plan that covers such events. If not, then what? Then somebody else pays.

No, these guys embrace the Wild West solution to the health care conundrum. You get to look at the cards in your hand and make a bet. And if you go bust, the county takes your horse and saddle and your neighbors insurance rates go up.

We need leverage folks, and leverage is in numbers. Splitting us up, as Cameron and Otter propose just weakens our leverage. It is no mystery that the leading employer in most Idaho counties is a health care institution. It is a huge industry, a huge sector of our economy. If we don’t like how it’s working, we can try to organize and get the leverage to solve the problem. That’s what our leaders should be doing.
 

A modest proposal

schmidt

It’s hard having discussions about difficult issues, but we need to. The state legislature should be a place for our elected representatives to have these difficult but necessary conversations. Getting the discussion going is an art.

Advice can be helpful; I sought it when new to the office. After I first got elected to the legislature I called the person who had served in the seat before. He wouldn’t talk to me. And I have had no conversations with the person who defeated me in November 2016. So I send this advice out to Senator Foreman, knowing it is unsought and probably unwelcome.

Senator Foreman, I appreciate your strong stance on abortion.

I believe a civil and honest discussion might help us all understand just how important this issue is to each other. I understand from what I read in the press that your “solution” would be to make abortion once again a crime: murder. And since you won your seat with the majority vote in your district and you clearly voiced your position in your campaign, I can understand that you may believe the majority of your constituents support your proposal. So, let us all see what in fact you propose, for I have many questions about your intentions.

I came to understand the legislative process as one of building support among my colleagues. But the legislature allows for another process, if such support is thin. All legislators can have bills printed for all to read and consider through printing a “Personal Bill”. This must be done early in the session.

So, Senator Foreman, if you have been unable to get the support of chairmen or leadership, print a personal bill. Let the public and your constituents know just what you have in mind, for I have questions.

You must know about this process. Indeed, I did this after waiting three years for Republicans to address the Gap population and Medicaid expansion. I thought we needed some discussion on this important issue. Maybe you’ll get a generous chairman to give you a public hearing, like I did. Understand this will not please leadership. Maybe the hearing will be longer than 40 minutes and more than 10 people can testify. Maybe the conversation and consideration will be civil and thorough. I would hope so. For I have questions.

If abortion is to be a capital crime, will you propose any statute of limitations? Will women or practitioners who have made this painful choice ten years ago be subject to prosecution? Will the data on abortions collected by the Department of Health and Welfare, as required by law, be subject to review of prosecutors? Since abortions are carefully counted by the DHW, how will we know if there are actually less occurring, as most people seem to want, since they will be a crime? Who will care for the families of women incarcerated for this crime, since many who have abortions are already mothers? As you have pointed out, murder is illegal, but it still happens. And we do prosecute. I have heard you consider an exception to this crime to be allowed if the mother’s life is in jeopardy. Who makes this determination, a judge? A medical professional?

Senator Foreman, you could help us all with this important discussion. Let us see your proposal.
 

No slogans

schmidt

I want to applaud Director Cameron and former Director Armstrong for their creative and courageous work to bring down health care costs for all Idahoans and bring more of our neighbors out from under the threat of medical bankruptcy.

If more of us would pay attention to this critical problem that all of us face maybe we could get past the slogans and sound bites and do some work for the common good. It shouldn’t be about Democrats or Republicans, because we are all in this mess together.

The Medicaid expansion I fought for under the Affordable Care Act was not a final solution. No, it would have been a simple first step: get all Idahoans covered by some health insurance plan. No more Catastrophic Fund tax burdens, no more liens filed on weak assets and medical bankruptcy ensured. Unburden our low wage workers from this threat. But that didn’t happen. Maybe the voters will consider the initiative and it could move forward. But their path is steep.

If Idaho would have (or chooses to) expand Medicaid coverage, the next step for all insurers (Medicaid is an insurance) would have been exactly what Armstrong and Cameron have proposed. Managing the most expensive patients is the holy grail for lowering health care costs. Fifty percent of all health care costs can be attributed to 10 percent of the population.

Can private insurance companies do this better, or a government program, such as the Directors have proposed? I believe the market could have answered this. Whether Medicaid or private insurers had better success, the voters could have decided where these patients are best served, on the exchange, or on Medicaid. I would hope in such a consideration the voting public would consider the justice of such a program, not just what it would mean to their own pocketbook.

Medicaid already cares for many disabled and expensive care patients. Private insurers see these folks as outliers in their actuarial calculations. Before the ACA, these patients would have been denied coverage. No, a couple dozen expensive medical conditions in a small insurance pool will drive up costs for all. I can imagine the insurance industry would gladly welcome the Armstrong/ Cameron proposal. Will Idaho taxpayers commit to support folks with these expensive conditions when the next economic downturn hits and revenues drop? Will budget writers cut schools, or expensive cancer patients?

Their proposal means we will sort sick people for insurance by their diagnosis and prognosis. Does this remind you of the slogan of a former Vice-Presidential candidate? I am trying to avoid slogans. I ask the careful reader to consider what it means to sort people in such a way. Does such a law, such a program fit your sense of justice? It doesn’t fit mine.

The inscription carved in marble above the US Supreme Court pillars reads: “Equal Justice Under Law”. I can think of no higher ideal.

All people deserve access to appropriate health care. We can afford it. We already spend twice as much per capita on health care as other developed counties. We just have to think more of the common good.

Nobody minding the store

schmidt

Democrats are getting their hair on fire about all of Trumps executive orders. Well, I’m an Idaho Democrat so I’m concerned with Idaho’s Acting Governor’s executive orders. My hair isn’t burning, but I can see why the public isn’t paying attention. No CNN coverage, no FOX News, and no real change from the same good old boy network that’s been ignoring our state governance for the last eleven years.

Lt. Governor Little issued an Executive Order recently in Governor Otter’s absence. It was almost a sad joke. I can’t blame the audience for not laughing. Executive Order 2017-6 committed state agencies to review professional licensing boards in Idaho.

In my six years in the legislature I watched many professions come to the legislature asking for licensure. Understand that such a legal power actually gives a monopoly to those licensed. You aren’t allowed to cut hair for money unless you are a licensed cosmetologist. The list of professions licensed in Idaho is long; from acupuncturists to plumbers to morticians, the legislature has chosen to protect the public by requiring professional licensure. My criteria for such requests for licensure required two questions to be answered: #1. How is the public health and safety promoted by this monopoly you request? #2. Will you be able to administer your profession? Apparently Acting Governor Little has questions. I do too.

Does this legal monopoly status really protect you? Recently a dental hygienist in Payette, Idaho was convicted in Federal Court for getting paid while misrepresenting herself as a dentist. Notice, no state prosecution, and the state Board of Dentistry only “pressured her” to give up her hygienist license a year ago. Nowhere in this indictment is the question of quality of care addressed, just whether the provider actually had the legal license to do what she was doing, and charge for it. It begs the question of whether professional licensure actually serves the public welfare or instead regulates the marketplace. What do we want from government regulation of a profession?

The legislature washes its hands of that question by turning the administration of the professions over to, guess who, the professions themselves. The only governance over all these 50+ state-granted professional monopolies is given to the executive branch: the governor. That elected official appoints the board members who then regulate themselves. Or are supposed to. Only through that office can we the voters have a voice if a profession abuses its monopoly.

Our elected governor is supposed to appoint people to each professional board with the public welfare in mind. If the appointees are only interested in protecting their own piece of the pie, the governor should see that and act. He hasn’t been doing his job. And that is the joke Brad Little offered to a disinterested electorate May 19th. “Hey, no one’s minding the store! I’ll ask some bureaucrats to make your change!”

Here’s an example: In 2005 the Idaho legislature enacted licensing of naturopathic physicians. Governor Otter appointed a five member board. The board met and issued 11 licenses, then never functioned again, to govern themselves, to repeal or issue more licenses, but in fact sued each other and been sued, proving its inability to self-govern. And the executive branch didn’t do squat. The legislature finally repealed the statute in 2015. How many other licensed professions out there are not functioning? The legislature can’t make the governor do his job. But the voters can.

Full disclosure, I answer to one of these professional boards. I am a licensed physician. I pay my annual fee to the Board, and they decide if I should get a license. I pay attention to their actions and applaud their efforts. I wish we could do more to improve the performance of our profession.

It’s just an issue of who’s in charge. And the joke is: it’s us, the professional licensees and the voting public. We ought to wake up. It’s only fair to expect our elected executives to do their job.

Funding the highway

schmidt

The Idaho legislature is tied in knots at the end of a do-nothing session. They got their budgets filled out with very small exceptions to the governor’s recommendations and want to head out of town.

But the Idaho House, where all revenue bills must start wants to cut taxes. And the Idaho Senate wants to fix our roads, but they can’t write a revenue bill, so they propose borrowing money based on future federal gas tax payments (GARVEE). And in the mean time we citizens better all slow down, swerve around the potholes, fix our blow tires and replace our bent rims.

Idaho has known about the road funding deficit for years. Maybe Trump’s infrastructure promise will bail us out, but he’s also trumpeting tax cuts and a border wall. Why can’t we step up and solve our own problems? It’s courage folks, not asphalt we lack.

This winter exposed some real weakness, but it really didn’t happen with the rain and snow. It’s happened because we haven’t had the courage to confront our problems. How bad is it? You can’t get from Plummer to St. Maries along State Highway 5 now, it’s slumped and impassable. And that county elected a state senator that thought “Idaho roads are just fine”; he campaigned that the gas tax increase was “stealing money out of your pocket”. I 84 between Boise and Nampa was one lane this winter due to deep potholes, even closed for a few days. House representatives staged a little press conference to say “something needs to be done!” but their spokesman and 5 others in the gaggle voted against the gas tax increase in 2015. So what are your suggestions, elected leaders?

Our governor had the courage and insight to commission a poll a few years back to ask the voters what their solutions might be. Guess what? Voters wanted the roads fixed, but they didn’t want to pay for the job. I want my house fixed up too, but I understand I should pay for it. But then, I own my house. Do Idahoans think they are renting this state? Do they expect some landlord to step up and fix it?

In so many areas Idahoans say they want the Federal government to back off, leave us alone. So why would we trust the feds to bail out our crumbling roads? Idaho leaders are listening to you, their constituents, and that is their job. We the people need to tell our leaders we accept the responsibility of ownership. Shared ownership is still ownership. And we want to share in the costs to maintain what we own.

Good leaders are barely felt; it’s like we all want something and it gets done as if by our own will. But leaders can set the tone; they say things over and over, giving us ear worms, and sometimes we come to believe these phrases. We have elected local leaders who sing the song of less government, less taxes. We can’t fix roads without paying for it.

I’m asking for a little help from our leaders. But we need to let them know we are ready to be responsible.

Keep the puppy

schmidt

The ObamaCare replacement plan the House Republicans are offering gets me off the hook for paying the penalty for being uninsured, but it’s like they want to give me a puppy. There’s a bigger obligation behind this little cute furry thing. Policy makers need to be honest about the puppies they are handing out. And we the voting public should be honest about whether we want a dog.

I dropped my state funded health insurance as a State Senator last year to try to prod my fellow legislators onto action. It didn’t work; they are still sitting on their hands about health coverage for all here in Idaho. Even though I voluntarily joined the 80,000 uninsured here in Idaho to make a point, I was still subject to the Individual Mandate penalty. The House “Repeal and Replace” Trumpcare solution would get rid of that penalty retroactive. It seems they think a tax incentive is a better motivator than a penalty. It’s like they think the Obamacare penalty is a kitten and their Trumpcare puppy is way better than a kitten.

All this posturing, from both Democrats and Republicans about how to “fix” the healthcare problems in this country is skipping some fundamental questions.

1. Do we as a country believe that all people should have access to health care?

2. Is private insurance the way such healthcare should be funded?

3. Does the answer to these first two questions have anything to do with the overall cost of healthcare?

The answer to the last question is YES.

So let’s look at #1. As long as people do not accept the universal need (or requirement) to pay into the risk pool of health care, and instead want to roll the dice about their future health care needs, then the health care industry will shift the costs for the uninsured onto those who are enrolled. And the cost of insurance will climb like it has for years now. When costs are shifted, they cannot be controlled, no matter how transparent or vibrant the market.

I can appreciate the incentive to “go bare”. 95% of health care costs can be attributed to 50% of the people. It’s tempting to think you could just flip a coin and stay out of that expensive group. I served on the CAT Fund Board here in Idaho for 5 years and we paid millions to hospitals for those who wanted to choose heads. Bad things happen: medical costs lead bankruptcy filings. This thinking is antithetical to the principle of shared risk when one enrolls in an insurance plan. Fundamentally, are we willing to join a group and share our risk?

If we as a country cannot agree that EVERYBODY should be in the insurance pool (note, I did not say “private” insurance), then we have little hope to control rising healthcare costs.

The answer to #2 starts another rabbit hole of “what if’s”. As long as we stick with the private insurance model, and the majority of the insured get their insurance through the workplace, the self-employed, the small businesses will get the short stick.

Private insurance companies don’t want to deal with the individual or small group health insurance market. Their business model works best with large groups of patients. This was what the “Exchanges” tried to fix in the ACA. But such markets needed constant adjustments as the players responded to cost pressures. And we have not had a willing congress to make any adjustments for 6 years now. The kittens can’t play with the puppies.

I want people to have access to healthcare. I want healthcare coverage to be portable, adequate and affordable. The Trumpcare proposal will result in more uninsured, rising costs and less leverage to manage costs. I want my elected representatives to act like adults and consider the importance of this issue.

Health care costs are robbing the middle class and fear of catastrophe is crippling our productivity. These clowns can keep the puppy. And I don’t want the kitten either. We need real solutions.

Connecting to constituents

schmidt

It seems our Idaho Congressional delegation was ducking some heat last week. I can’t blame them; who likes being called to task? But such is the duty of the public servant.

At least I thought so; but it’s tough work. That’s why we call these elected officials “leaders”. Who you listen to and how you listen makes for a good leader. We the people should expect more from our public servants.

A few years back a group of soil conservation commissioners asked legislators in the North Idaho region to come to a lunch presentation to explain the work they did. I was familiar with their work; I’d met with my county conservation commissioners at least annually since being elected. They are elected officials too.

I had studied their budget on JFAC and understood their governance and the problems some districts were having throughout the state. But I had encouraged Linda to set up this meeting since I had the impression many legislators didn’t know the work they did. She was the most active commissioner in that county. Her presentation was brief, the lunch modest and then the conversation started. Don, a North Idaho legislator was frank. He said he saw no appropriate role for government in this and did not support the idea of taxpayer money being wasted on these projects. Linda thanked him for his honest response and asked him if there were things he was working on to help Idaho in the coming legislative session. He responded that he would meet with his Republican Party central committee and get their thoughts before he started on any legislative work. I believe this is all the work some complacent legislators do; talking to like-minded party members. That’s not leadership.

It’s a lot of work to stay connected to 47,000 people, the population of the average legislative district. But public servants should do this work.

Some legislators write email newsletters, a decent attempt at one way communication. The Capitol legislative support staff facilitates this, but I always did this on my own dime. I’d send out an email newsletter weekly during the session to about 1500 recipients. I wanted more for the mailing list, but it’s amazing how many rural folks don’t do email. Some thanked me for the updates and the links to other articles. I saw some other legislators do this, but not many. And honestly, that’s only 3% of my constituents.

The Idaho State Senate gives each state senator a budget to go to meetings (about $1200/year) and to mail “End of Session” letters (also about $1500/year, so that means less than 3000 letters). I always sent these out  (though less than a third of senators do) and I went to as many meetings as I could. This funding is quite generous, I hope it is continued. It is not intended for campaigning. One Idaho Senator got in trouble when she sent her letter to Republicans in the new district she got redistricted into back in 2012 asking for their support. The line between constituent work and campaigning needs to be clear, though good constituent work should make campaigning easier.

I held town halls during the legislative session on a Saturday when I would return to the district. I’d hit both county seats and five or six of the towns in the counties. The attendance would range from 3-4 folks in Juliaetta and Kendrick to 40-50 in Moscow. I was always a little perplexed that most who attended were supporters. Rarely did folks show up to give me a hard time, though it did happen.  I welcomed it; I saw such as an opportunity to exchange ideas, listen, for them to persuade me, or for me to explain my positions. I didn’t think we should all be in agreement, but that seemed like what it often was. Too often we only spend time with those we agree with.

I served a split district. That means our legislative delegation (one senator, two representatives) had both Democrats and Republicans. Idaho has 35 legislative districts and after this last election there are now just three split districts (5, 26,29 ). In a district dominated by one party, outreach is probably not necessary to get reelected. One-party dominance fosters a disconnection between elected representatives and their constituents.  Why are we so segregated? Why does the map of red and blue show such bright differences between urban and rural?

Idaho has some problems to solve. Both sides need to be talking, but more, we should be listening and hearing each other. Don’t be afraid. Talk and listen to those you may disagree with. Who knows, maybe you’re a leader.