Press "Enter" to skip to content

Posts published in “Schmidt”

Don’t be cruel

schmidt

I forgive ignorance. I tolerate stupidity. I cannot abide cruelty.

If you believe government programs foster or promote or have created slothful citizens, please, look in your heart and figure out where this sort of belief comes from. It is pretty widely held. I just heard a local politician espouse this tripe.

I will not dispute there are lazy people. Sometimes I don’t work as hard as I should, but that’s not because of any government program. The idea that programs developed to ease the burdens we all may experience in life make us lazy and then more likely to wallow in our mistake or misfortune tells me what you think of human nature. And how we react to that concept can be cruel. Don’t be cruel.

When I first ran for office I met with a local group of union workers. Their demeanor and tone told me clearly, they wouldn’t be voting for a Democrat. But I got them to tell me what was important to them. One young man asked, “Why doesn’t Idaho drug test welfare applicants?” I told him I’d look into it.

This is a popular refrain, since many believe those getting a handout from government are slothful, lazy and misusing any of our dear tax dollars. And if this is the case, we could then deny benefits to miscreants, saving tax dollars. I’m all for cutting costs, so I studied it. Many states do such testing. It has told an interesting story. The percentage of welfare applicants who test positive is well below the general population average. This drug screening program, especially when no treatment is available does nothing to reduce tax expenses, in fact the cost of testing far outweighs the money saved in denied welfare benefits.

If your goal is to help people with a drug problem, you’re going to have invest more. If your goal is to just deny benefits, be honest about it and just cut the program. But it would be best to look in your heart before you go designing any program, because that’s where this all starts.

The same can be said for the work requirements being suggested for Medicaid eligibility. Do you really think a single mother of three young kids should go without health insurance because she can’t work more than 20 hours a week?

There is a government program that has this wrong: Social Security disability. I do understand that people can have disabilities that can keep them from doing some work. But to be declared “disabled” then eligible for benefits the rules prohibit the disabled from “Substantial Gainful Activity”. In the past 20 years we have seen our disability rolls skyrocket. About 5% of the workforce are classified as disabled. And they aren’t counted in the unemployment calculations. Less than 1% of folks going onto disability ever return to the workforce. This program can be a cruel trap. A program to help the disabled should not discourage gainful activity.

People can be cruel. Government can be cruel. People are government. Get involved, speak up, vote. Don’t be lazy. Don’t be cruel.
 

Home maintenance

schmidt

When a place feels like home it’s a treasure. But all homes need maintenance.

I was born in a city but moved to a small town when I was very young. As I grew the town’s population exploded. When I started kindergarten, we had one small high school, but by the time I graduated from the new second high school, graduating class sizes for both high schools ran in the 400-500 range. The next year there was a third high school; I went off to college and never went back. That town grew too fast to feel like a home to me. I hope it feels like home to its current couple hundred thousand souls.

Some Treasure Valley communities in SW Idaho are struggling with such rapid growth. But many small Idaho towns are getting smaller. In most of these towns their populations are getting older on average. The economic effect, then the cultural affect is clear. Older residents often rely on fixed incomes called “transfer payments” (retirement income, Social Security, disability benefits) and they see taxes as a threat instead of an investment. Without investment and maintenance small towns crumble and shrink.

These aging, shrinking towns often struggle to fund their schools and infrastructure since such investment requires citizens to see the value of such expense, and be able to afford investing in it.

But investment doesn’t always come out of your bank account. Planning, organizing, communicating, and just showing up are worthy investments to make a place feel like home.

One of the blessings of public service is learning about new things. In my first year in the Idaho legislature I got appointed to the Idaho Rural Partnership Board. I had no idea such an entity existed, but there you go, I’m now on the Board. Before my first meeting (in downtown Boise) I asked a fellow board member why we didn’t meet in a rural town. “Oh, nobody would come,” was the quick answer. I started my IRP service with a jaundiced eye. But I learned some things.

The most valuable service offered by the IRP is the community reviews. These are all available for your reading on their website. St. Maries had one done in 2006, Plummer in 2017; they do about three a year in every corner of the state. They are a lot of work, lots of meetings and tours with local leaders, businesses, community members.

I would encourage you to read your “Community Review” if you haven’t. This isn’t out of town experts coming to give the locals their wisdom. The value comes when a community speaks up, reflects on its needs and character. And the best part is, each community does this work itself. Or, it could just talk about it for a day or two, then not do anything. That’s why looking back at these reviews after a few years is quite helpful.

If towns feel like home, can sustain their residents and support the community, I call that thriving. Don’t expect Boise or Washington DC to have answers if you think your town needs a boost. It will be your efforts that make your town great again.
 

Statewide funding for charters?

schmidt

Charter School Facility Funding could be a state-wide solution. Idaho currently has two ways of supporting public school facility funding.

Charter schools receive a fixed amount per year based on their enrollment and what districts raise. The state has allowed districts to run bond elections that need a 2/3rds majority to pass. This uneven playing field does not satisfy the constitutional requirement that education in Idaho be “free, common and uniform”.

My town is blessed with a great public-school district. The district sponsored the first charter school in the state. When another charter school applied to the district for sponsorship, the district deferred. The state charter commission was established and now charter schools are sponsored from Boise, not locally. So, our town has the public-school district, a district charter school and a state commission sponsored charter school.

The state-based charter school recently announced they have plans to build a new facility. This will be funded through a system established by the legislature in 2012. Charter schools receive funding for facilities straight off the top of the state-wide schools budget. The amount is tied to both enrollment and what all schools receive from local bond and levy income for their facilities and will reach a maximum amount (50%).

In 2005 the Idaho Supreme Court declared the way public schools have to raise money for facilities unconstitutional and expected the legislature to solve this problem. The legislature has done nothing to solve this. But they sure solved it for charter schools.

Full disclosure, I was in the Idaho Senate when this was debated and voted on. I voted against this scheme. A colleague posed a question during floor debate: “If this is such a good idea for how to fund facilities, why not extend it to all schools?” There was no answer from the sponsor. But it’s a valid question.

The Supreme Court’s decision that school facility funding is unconstitutional was based on the wide variation from district to district we see in support for facilities. Bond elections are brutal; a high bar to clear and tax bases vary dramatically. The Idaho Constitution requires a common, free and uniform education for all. Automatically giving charter schools a fixed percentage for facilities based on the amount local districts have to sweat blood for is unfair and clearly unconstitutional. Basing all schools’ facility funding on enrollment is very fair and uniform.

We have a solution staring us in the face. There is a legislative interim committee studying the “school funding formula”. Ask them why they haven’t considered this solution. Keep in mind, the vast majority of school funding goes to pay people to teach our kids, not build classrooms. But our current system that takes from paying teachers in all classrooms to help only charter schools with their building needs is unfair, unconstitutional and bogus. Expand the enrollment-based funding for facilities to all schools. This would provide more uniform facilities, lower local property taxes and satisfy our constitutional duty. What’s good for charters schools should be good enough for all. Let’s be fair.
 

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.