Writings and observations

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.

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Schmidt

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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.

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Schmidt

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I have been wondering about Idaho and how voters here are so inclined to vote by party. Maybe they are everywhere, but I’m here so I tend to think about Idaho.

A recent trip to visit my daughter in Utah brought Idaho history into this contemplation.

Three quarters of the way back to the Palouse from Salt Lake City on a long late-winter drive I was feeling lucky coming down Goose Creek from McCall to Meadows Valley. I might make it home by dinner with the time change. When I hit a pot hole just past Packer John Cabin I winced, like I had the 50 times before on these winter-worn roads, but I thought I was still lucky. The thump-thump-thump I heard in Old Meadows told me I had a problem. I drove on the flat to the junction; no place to pull off with the snow banks.

Could it be a coincidence that Packer John Cabin was my downfall? It is a little visited Idaho State Park. In 1862 “Packer” John Welch was hauling goods from Lewiston to the Idaho City gold fields but deep snow brought him to a halt. He built the cabin to cache his goods, then came back in the spring to finish the trip.
In 1863, the Democrats tried to meet there to nominate a territorial representative to congress, but their communication was about as good then as it is now, and half the delegates got the wrong date, so they reconvened a couple weeks later to make the nomination.

The summer of 1864 the Republicans chose the midway location to meet. Their stock appreciated the lush grazing, there were fish in the creek and if the small cabin couldn’t hold them all, the big pines formed a fitting auditorium.

In those days, Idaho was populated with many refugees from the bloody Civil War. Democrats hated Lincoln and the Yankees who were attacking the southern “way of life”, though I doubt any of those early miners were slaveholders. Just look to the names of old mining towns: Dixie, Atlanta, Leesburg, and Sesesh (for secession). This faction also included most the southeast Idaho Mormon votes, since their way of life was threatened by a Federal government too. It was generally believed that Democrats outnumbered Republicans in those days. But Lincoln was a Republican and he appointed the territorial governors and judges.
Idaho, even before statehood had a political climate colored by national politics.

The recent changes in political power at the federal level must make Idaho republicans pretty comfortable. I sure wish they could agree on fixing some local problems, like the potholes and narrow shoulders that led to my shredded tire and $500 expense for repairs. We would all be better served if our representatives could keep their focus on the needs of our state.

Maybe the next state Democratic or Republican convention should meet at the small cabin by the creek. The delegates might notice the creek doesn’t have much fish, the grazing is all fenced and privately owned, and the big pines have long ago been logged. And they should watch out for the potholes.

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Idaho voters thought it wise to place the legislative authority for administrative rulemaking review into the Idaho Constitution this last November (HJR5).

Now we are seeing the arrogance and hubris of the legislature in action. The recent rejection of some of the Education Standards by the House Education committee is using this authority to bypass the legislative process.

This decision to reject some rules was based solely on the whim and preference of some committee members. The newly passed Article III Section 29 reads in part: The legislature may review any administrative rule to ensure it is consistent with the legislative intent of the statute that the rule was written to interpret, prescribe, implement or enforce.

Show me the statute or legislative intent that declares it is not appropriate to teach global warming in Idaho classrooms or have such expectations for standards. Please point out the law; I can’t find it. If the legislature wants to pass such a law, they are free to.

They have passed laws to require the daily reading of scripture in the classroom (33-1604); a prohibition of consideration of global warming shouldn’t be so tough. But instead of writing a law, voting on it and getting it into statute, they have bypassed the policy making process the Constitution gives them and injected policy by rejecting an administrative rule. They broke the law and ignored the Idaho Constitution. But who will hold them accountable to this rule of law? Will we the people? Will the voters who elected these legislators be offended by this violation?

There are too many legislators in our Capitol with a conscience to let this transgression go by with a shrug.

The legislature has clearly violated the Idaho Constitution, both Article II Section 1 and the newly passed Article III Section 29. My complaint has nothing to do with how or whether I perceive the planet to be changing. I object to the arrogant disregard for the process, the rule of law.

Arrogance is a trait that needs constant vigilance to check. But arrogance is just offensive and rude, not illegal. This act was illegal. The legislature is empowered to make laws but we are all obligated to uphold the laws.

If the legislature chooses not to follow sworn oaths and disregard the very laws they have written and instead act on whim, our tenuous faith in government is in jeopardy. What next?

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Idaho conservatives are proud that the state runs a balanced budget and doesn’t do deficit spending like “the Feds”. But I have long maintained we do sustain deficit spending in three areas, we just don’t put these figures on the balance sheet, so they are easy to ignore.

Our infrastructure maintenance deficit for just our roads and bridges amounts to about $190M a year; further, deferred maintenance on state owned buildings adds another $500M, not annualized. I don’t consider it a conservative value to neglect what you own.

The second running deficit not on a balance sheet is the constitutionally required investment in public education. Governor Otter even acknowledged we weren’t sustaining this obligation a couple years back, and we are paying the costs of this deficit in our low wages. The symmetry of Idaho being 49th in the nation in education spending and 50th in average household wages is not just a coincidence.

But two articles in our local paper this week highlighted the third area where we run a deficit: governance. In two separate incidents, two employees of different small water or sewer districts have been charged with misuse of public funds. One seemed a pretty clear case of fingers in the cash drawer, but the other made me think of a slowly crumbling stone wall, falling down out of neglect.

The commissioners of these small districts are elected officials, thus responsible to their constituents. They should have procedures in place to maintain the integrity of entrusted funds. Such procedures require work and deserve reward. But I doubt the small towns have many citizens clamoring for this thankless responsibility. I know how hard it is to get people to run for school boards, but think what happens to institutions that aren’t supported: they crumble.

One of the employees charged with misuse had been the treasurer for 16 years, after all the other board members resigned. She collected payments in a jar by the register in the small town’s café. She employed her son to do maintenance work because she couldn’t physically do it at the age of 80.

I am hearing all the time from folks in our rural areas how things would be better if “the guvmint would just get out of our business”.

This sentiment ignores the fact that we, the people are our government. And if you have an institution you rely on be it water from the tap, the waste you flush, the power in the socket, the roads or the schools, if you aren’t willing to contribute something, your valuable time or some of your wealth or income to that institution, it will crumble. But even more insidious is the growing belief that our elected officials are all corrupt or incompetent or self-serving. When or if this proves true, prosecution is in order. But if we citizens have failed to invest in our civic duty and we let the institutions we value degrade, there is some blame looking back at us in the mirror.

Finally, if you have a neighbor who does donate some of their time to city council or cemetery district service, thank them and maybe wonder what they deserve for such effort besides your generous gratitude. If you expect such service for free, you will probably get what you pay for, maybe worse.

Public service deserves our respect, our vigilance and our gratitude. It is a debt we owe.

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Schmidt

schmidt

Small ideas take a lot of words; big ones need just a few. This was a small idea I stumbled upon, and the idea itself is not that important, but what happened, more so, what didn’t is the story. People here in Idaho are dying and Idaho’s US Senators aren’t doing much for us. That’s the real story here.

The Prescription Drug Abuse Prevention Workgroup was started 6 years ago to address the prescription opioid epidemic in our state. Idaho, like all states has a prescription monitoring program (PMP). At one of the workgroup meetings I was made aware of a gap in our state monitoring system. Federally sanctioned methadone treatment programs and Veterans clinics are not required to enter their controlled substance prescriptions into the Idaho PMP.

That means if a veteran is on oxycodone for chronic pain and he comes into the ER wanting something for pain and doesn’t tell the ER doctor he’s taking the VA meds, the doctor can’t see the prescriptions in the system. I know; this has happened to me as an ER doctor.

The reason for this exception lies in federal law. I asked the Director of the Board of Pharmacy about this and his eyes lit up. “Do you want to know about this? I have all the research.” He shared with me the specific US code, some proposed changes from different US Senators over the years. It seems not just the uninsured are dying from lack of action.

Congress isn’t dead yet; but the reaction I got to this small idea from Idaho’s Senators was moribund.

This should have had some traction since the prescription opioid epidemic was in the news so much and it is rampant in our state. I drafted a brief letter on my state senate letterhead describing the issue and asked for a conversation. I was sensitive to party affiliation issues and got a Republican state senator to introduce this idea to our US Senators and sent off the email. That was a year ago.

THREE MONTHS later I got an email reply thanking me and telling me there would be follow up. THREE MONTHS after that I got a call from an intern working with one of the senator’s offices. We had a polite conversation and the intern asked me a bunch of questions that could have been answered if he had read my initial email. Now we are six months later, I am no longer a state senator, and I doubt there will be any action.

Was it a bad idea or that it came from an Idaho Democrat, or is just Washington DC so crippled? I would have appreciated some response either way. Maybe a new administration will invigorate Congress.

I understand that things take time.

I understand that many of the folks with different interests need to be involved, but there is no reason I can understand why Methadone Clinics or VA clinics should not be reporting their prescriptions to a state PMP. In fact, the Virginia Attorney General sent a letter to HHS last spring asking for the same change. Idaho did not sign on to that request, but 31 other states did.

Hello Congress: people are dying. Get to work.

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Schmidt

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What I stand for is what I stand on.” – Wendell Berry

If you love where you live, stay put. Get to know your neighbors, your countryside, the history and the institutions. Ask yourself what it is you love, and then find out what your neighbors love; surely you have a lot in common besides your zip code.

You may feel marginalized; indeed you may experience prejudice. There is good evidence that people feel more strongly now about party affiliation than they do about race. It seems now people are more nervous about a family member marrying into the other political affiliation than across a racial divide.

Now relax, don’t hide your face or use a different drinking fountain. Understand we are all in this together, no matter the insults and labels that come too easily to mind. For the community you love and our state to prosper, we all will need to participate. A good conversation is in order. Maybe you could start with what exactly your vision for prosperity means. Listen to your neighbor’s vision. These conversations require patience, respect and time. I hope you have all three, because nowadays it seems they might be in short supply. Show your neighbor you have some to spare.

Know you may be in a Facebook or CNN or NPR or Fox News bubble. The slant of those we listen to can make us think we are all knowing; disabuse yourself of that arrogance. Such humility can be hard when one feels marginalized, and it can be even harder when you feel affirmed. We all are on shaky ground.

Don’t let outrage be the slogan on your t-shirt, even if that’s what you see on your neighbor’s ball cap in the grocery aisle. Be yourself; a citizen with all our rights and responsibilities. And expect your fellow citizens to be too. Let them know respectfully when they fall short, but never shirk your duty either.

Know your community. There may come a time when your love of community is deeply questioned and my original advice to stay put seems questionable. But remember that there’s something here you love, and your neighbors must also. It is not unreasonable to be in a place where there is conflict. Lend your voice and your effort to this conflict so that a vision for prosperity can emerge. We need a shared vision.
Don’t whine and don’t bitch. Get to work. Is there a cemetery district that needs a commissioner? Could you make your city council stronger? Is your church serving your community, or just the parishioners? Do you have faith in the institutions that make your community one you love, and if not, what can you offer to restore that faith? We need work.

Finally, I ask you to question party affiliation; not give it up, but make sure of the value.

Does this branding we do serve us, and the communities we love? It can be such a tribal marker that bears no use for the vision we have for prosperity. If we weren’t looking through the colored lenses of the glasses we have put on, would the world, our neighbors, their vision for the future and ours look clearer? Don’t be afraid to take those tinting lenses off and see people, neighbors, and institutions in the clear light of day.

We are all flawed. We all need work. Let’s get to it.

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Schmidt

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The Idaho Department of Health and Welfare (IDHW) will propose a $11M expenditure to the legislature this session. The goal is to provide mental health and drug abuse services to recently released convicts who are back in the community. The idea is that such an investment ($1500/year) might keep some offenders from returning to prison ($30,000/year). About a third of Idaho offenders released to the community return to prison within three years.

This seems like a good investment in our community. I have little faith the legislature will see it as such. And here’s why. This cost to the Idaho taxpayer would be nothing if the legislature had considered expanding Medicaid eligibility. And such a consideration is toxic for the legislature, even though most Idaho residents consider it reasonable.

The cost benefit analysis of Medicaid eligibility expansion under the Affordable Care Act was looked at carefully four years ago by a work group requested by Governor Otter. The analysis showed that enrolling the uninsured would save Idaho taxpayers but did not include any savings for this group of recently incarcerated. They found such calculations too difficult. But with prompts from the Justice Reinvestment Oversight Committee and the Judicial Council, the IDHW looked at this as a source of savings to Idaho taxpayers and brings this recommendation. But they also brought PCAP last year (an expensive compromise) when the legislature had refused to consider eligibility expansion.

Both are attempts to get the legislature to solve the problem of access to health care to prevent expensive costs. And I predict the new proposal will die the simple death (as PCAP did) that the legislature wishes would come to all the uninsured, if only such deaths were as cheap as our current ignorance. But the piper will demand payment.

The legislature (and the Freedom Foundation) will see the IDHW proposal as a back door for Medicaid Expansion, which should have been done four years ago and now is dead thanks to Trump and Ryan. Idaho citizens have lost $2B in support thanks to our legislature and lack of leadership on any level. So is the ACA dead? What would be their solution? We have engaged the piper; people expect health insurance. Can Trump and Ryan roll that back? Is that their plan? I haven’t caught the tweet.

I am thankful IDHW has made such a proposal. Should the legislature have the courage to burden the taxpayers with such a program, now, at least we can count the dollars we are spending, so we can know how much we could have saved.

This is a tough issue. Providing appropriate care and paying for it are responsible choices we should all be willing to consider. I wish our leaders had the courage.

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Schmidt

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Senator Keough is right, small towns in Idaho need help.

Dialing in the details of the Tax Reimbursement Incentive (TRI) to suit smaller marketplaces is an appropriate move. This graph of population in the North Central region of Idaho gives you a sense of what small towns face. There are seven regions in Idaho; subtract South West (Boise) and then you can multiply this effect by six.

But I want to tell you the history of this legislation, so maybe you can understand why Idaho government is not functioning “at the speed of business” as former Idaho Director of Commerce, Jeff Sayer used to say was his goal.

The TRI started as a brainchild of Roy Lacey (D Pocatello) and Donna Pence (D Gooding) when they were in the Idaho House. The idea was to give companies who come to Idaho and start a business that pays more than the average salary a tax incentive that they could collect later if their promised development pans out. He initially proposed it to promote value added jobs in agriculture in 2012 and 2013. It got good reception from Commerce, the Governor’s office and some committee members, but the House Majority Leader Mike Moyle and Wayne Hoffman came out against it as “picking winners and losers”. It got killed.

Still, Roy worked all summer of 2013 with Sayer and rewrote the idea to include all businesses, based on a Utah model already in place. But Roy and Donna knew the slant of the field they were playing on.

So Sayer took the bill, with the Democrats blessing, to Moyle for the 2014 session and he agreed to sponsor. And it passed! Wayne Hoffman still hates it. But this shows that the Idaho Capitol is not quite the “arena of ideas” Speaker Bedke wants it to be. It seems that whose idea it is, or maybe the party affiliation of the person with the idea has influence.

Shame on us that our representatives are not there to do the peoples work, but instead find party affiliation as a prejudice to the common good. It may be no accident that both Donna and Roy retired from the legislature this last year. I question whether the partisan nature of the legislature serves Idaho.

Is this reflected in small towns? I have heard many constituents in these close communities express reluctance to acknowledge minority party affiliation. I can’t blame them. I’ve lived in this culture. And I’ve also seen minority party members dismiss any idea coming from the other side.

Such stances almost seem tribal. I hope we don’t start hacking each other’s arms off. It’s bad enough that we kill good ideas.

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Schmidt

schmidt

As EORAC (The Economic Outlook and Revenue Assessment Joint legislative Committee) starts it’s meeting for this year, I am reminded of a comment by a fellow member a few years back.

EORAC is tasked with recommending a revenue projection to JFAC so a budget can be set for the coming year. Idaho’s Constitution, like many states, mandates that government may spend no more each year than it takes in. Idaho tax revenue is of course mainly dependent on sales tax and income tax. Property taxes (also about a third of the Idaho tax burden) mainly go to local governments. Income and consumer activity is quite dependent on the economic climate, so the committee listens to many experts discuss their weather predictions for the coming year.

When we heard from Idaho Department of Labor in 2014, House Speaker Scott Bedke seemed surprised by Idaho low wages. At that time Idaho had the highest percent of minimum wage earners (now we are 49th), and the lowest average wage in the country (still 50th). The Speaker asked that the numbers be repeated to the legislators for emphasis and suggested we consider our policy actions to address this. He’s right; our state leaders should understand this predicament.

But it’s not news. This has been a long time coming.

This paper provides a good analysis of each sector. Interestingly, when I have had this discussion with Republicans who will talk to me about this, they point to 1980’s as when environmental pressures hurt logging and mining. But those Idaho jobs actually pay above the national average and have for the last 30 years. Health care workers have driven this decline the most; their pay has lagged and the sector has grown.

So why hasn’t the market solved this for us? You’d think businesses would want to come to a place where the workers get paid less, then as demand for workers increases, the pay would also. Idaho has had some ups and downs, but overall the 30 year trend is swirling the drain. State Impact Idaho tried to get people’s attention about this issue 4 years ago. They did a great job, but it sure didn’t fire up any voter outrage.

The consequences we see of this trend are that bright young folks are leaving the state for better employment opportunities elsewhere and older, gray haired, fixed income folks are coming in to take advantage of the low pay. Such a demographic change will have a long influence on the economy, and the politics.

A further consequence, since we started talking about revenue, is that since people make less, the state collects less revenue to pay for schools and other services. If incomes rose, we could actually lower the tax rate and still get enough revenue to do the work the state should be doing.

So what should policy makers do? First, I would wonder if any see this as a problem. My sense was that Speaker Bedke did, but I sure didn’t hear others join him. When I can get Republicans to talk about this they usually deflect the low wages to a comparably low cost of living in Idaho.

But they are wrong again. Idaho’s cost of living is about 30th nationally, while wages are 50th.

I have heard one lawmaker dismiss low wages as a problem. He also considered the goal of economic growth, especially for rural areas a mistake. “People like things the way they are; otherwise they wouldn’t be livin’ here. Why try to change things?”

As I sit in the distant back seat and watch EORAC hear testimony about Idaho’s economic forecast, I wonder who’s speaking up for the workers in Idaho? Do they have a seat on this bus?

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