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Posts published in “Schmidt”

How do we choose?

schmidt

Idahoans have chosen Butch Otter to be governor for the last twelve years, despite not thinking too highly of him. A recent poll showed he had a “net approval” of +12 while the state had a “Republican partisan lean” of +34, so he was actually 22 points behind any generic Republican. Idaho’s partisan lean was the third highest in the country.

A high-priced political consultant from back east presented some information to Idaho Association of Commerce and Industry 4 years ago about Idaho politics. He explained that Idahoans just weren’t politically engaged. His graphic evidence showed that ten times more Idahoans Googled “otter” meaning the cute river or sea mammal, than “Otter” the governor.

I always did a lot of door knocking when I ran for State Senate. I would knock and wait, then introduce myself, “Hi, I’m Dan Schmidt your state senator.” The most common response was, “You are?” and a look of surprise. I would ask about their concerns and explain why I thought they should vote for me. If the door didn’t slam, I would usually ask how they decided who to vote for. I’d hear: “Oh I decide based on the person, what I know about them.” That’s the myth people want to believe about their decisions, that they are informed and make wise choices. The truth is, most people can’t name who are their elected representatives, let alone what they stand for or any work they have done. It’s pretty hard to stay informed on all the details. And it’s boring. Netflix is better.

When an electorate is not engaged, there is usually low participation and certain default choices. Idaho voters show up in presidential year elections at a 70-80% participation of registered voters (which is less than 60% of eligible voters). Midterm years (like this year), it’s about 50-60% of registered voters.

There is no doubt partisan affiliation is the default setting when the voter decides to participate and only has limited information. The very strong Republican Party brand in Idaho right now is complicated by the question “Which Republican Party?” If the polling is accurate, Proposition 2/ Medicaid Expansion has pretty strong statewide support. Even a slim majority of Republicans seem to support it. Yet Republican Lieutenant Governor candidate Janice McGeachen successfully got the state Republican party to condemn Prop 2.

The last time Idaho Republicans went through this sort of test was when Otter (not the cute one) had the gumption to have a fight over establishing the state-based health insurance exchange (Your Health Idaho). Many Republican legislators were condemned by their local county party committees for their support of this brave initiative. YHI went on to be the most popular state exchange in the country; indigent and Catastrophic Health Care costs plummeted, reaping the general fund a tidy return and decreasing Idaho’s uninsured rate significantly. But that bitter fight left some deep scars in that big tent Republican Party.

Will Republicans shy away from an intramural fight before the November election? Some aren’t afraid to make their stance known. Twenty Republican House members signed on to opposition of Prop 2 last week. Most moderate Republican candidates I’ve heard aren’t willing to commit. And if their brand is strong enough, and the voters aren’t too engaged, maybe it won’t matter for them. They might welcome being mistaken for a cute water mammal.
 

Generalizations

schmidt

We all know generalizations are wrong, but we keep doing them, don’t we? I’m just going to address one today.

I keep hearing the refrain that bleeding-heart liberals always expect the government to do things for them. Let me tell you this story.

Over twenty years ago an aging married couple wondered how their son, afflicted with schizophrenia was going to fit into his community. They knew they wouldn’t be around forever to supervise his care. They hit upon a plan.

With some help from some others in our small town, they purchased an older home and made it suitable for six residents and a supervisor. The vision declared they would provide housing and minimal supervision for citizens with mental illness to live in the community. They formed a nonprofit entity with a board to oversee the home. The business model was that the rents paid by the residents would cover the maintenance costs, and the supervisor could live there rent free. The residents would be screened and their cooperative behavior was an expectation of continued residence.

Honestly, I don’t know if this founding family was Republican, Democrat, Socialist or pagan; they just sound pretty common sense to me.

I learned about this in my fifth year of my six years in the Idaho Senate. The board president sent me an email, asking for a meeting. I assumed they wanted me to support some sort of state funding, since I was on the Senate Health and Welfare Committee and the Joint Finance and Appropriations Committee. Everybody always wants government money, don’t they? But they didn’t. They just wanted me to know about their institution. They were indeed bleeding-heart liberals. But they didn’t want a dime from the taxpayers.

To be honest, the only way some of their residents could afford the rent had to do with their disability. They did get taxpayer money to support their living. Some had disability payments. Most had Medicaid or Medicare to fund their medical services. Some indeed had regular employment, though often part time and low wage. But work can be important to keep one in community.

It is just six citizens with mental illness this foundation serves, and our community probably has hundreds more eking by. But it truly is a noble vision; and an accomplishment to be proud of.

I have driven by this house many times in my small town. I did not know its purpose or function. I greatly appreciated them sharing their story with me. I worry that elected representatives who won’t meet with either bleeding-heart liberals or flaming conservatives won’t know the stories of their communities.

There is one cliff hanger to this tale. The bleeding-heart liberal board members I met with were all much older than me. And they were having a hard time finding community citizens of a younger age who would take on this role of governance. It is a small job. Let’s hope somebody will step up.

Next time you think you know what’s in the heart of your bleeding-heart liberal neighbor or your flaming conservative boss, take a step back and have the courage to have a conversation. We all need it.

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.