Posts published in “Schmidt”

It seems Republicans everywhere want to have work requirements for people who receive Medicaid health insurance. Our governor has said he’s on board, as has the director of the Department of Health and Welfare. The legislature has long argued for this, and they are again. Idaho has long had a request pending.

And this Medicaid work requirement plan is in the “Big Beautiful Bill” Trump has before Congress. If we can just get enough savings by kicking people off Medicaid, we can give the wealthy their tax cuts.

I understand the concern. Why should us taxpayers give our tax money to folks loafing on the couch all day? If that’s the case.

I first ran into this sentiment when I was campaigning for office. A local labor union gave me a chance to make my pitch to them. Democrat, Union, you’d think we were simpatico. Maybe not.

I introduced myself and then asked them what they wanted from the state government. The young guys were reluctant, but finally a guy spoke up. “Why don’t we drug test people who want welfare?”

I told him I would look into it. After I got elected, I did.

Some states had imposed this testing. There was widespread belief that druggies were taking our tax dollars. It must have been on talk radio.

The actual numbers showed that the cost of drug testing and the administration of this requirement had added significantly to the taxpayers cost of the program. Further, the number of folks using drugs on Welfare was well below the number of the general population. So just what is your point?

I believe most folks do not want to give something out through government-imposed taxes to another of their fellow citizens who might be undeserving of their generosity. I understand this sentiment. And I’m an Idaho Democrat.

But the laws we write are supposed to promote domestic tranquility and the common good. Anyone remember that?

So, let’s look at the work requirement proposed for Medicaid health insurance. Idaho’s proposal has many exceptions for “work”. Caretakers, moms, folks recently unemployed are exempted. So, who might be abusing this government benefit? I would argue, it’s a very small fraction of the Medicaid population.

Maybe you want to build a department of government to find these scofflaws and make sure they don’t have health insurance that we are all paying for. Okay, so we add to the bureaucracy. That’s what you want?

Given our current system, that is that health insurance is a work-related benefit, it makes sense that we should be pushing people to gain employment, and then their health insurance would be the employer’s problem, not us taxpayers.

So, here’s the deal I offer you “work requirement” afficionados. And I believe it is a plan that would be accepted by our federal partners.

Let’s do an experiment.

Idaho should propose to the federal government, our Medicaid partner since they pay 70% of the bill, a study.

We get to impose Medicaid work requirements on half of the folks who qualify for Medicaid. We study this half, and also the half that don’t have the requirements. We watch them for their long term, let’s say five years, outcomes. How many become employed and off the dole? How many just stay uninsured and a burden on us all.

Do we really help anybody with this requirement?

I have my bias.

You probably do too.

Let’s study the question.

This has been done only briefly before when Arkansas instituted work requirements. There was no randomization. The results showed folks left Medicaid because they couldn’t manage the bureaucratic mess.

Maybe that’s all some folks want. Kick people off.

It comes down to the question of whether you believe people, our society, your neighbors, all of us, are better suited to serve the common good if we have health insurance.

So let’s study this work requirement thing. Let’s see if it helps people.

 

Congress is trying to squeeze money out of Medicaid to pay for the tax cuts. They’ve got to come up with the trillions somewhere, why not healthcare for the low income?

Their current scheme is to take away a scheme states came up with years ago to augment the Federal money they were getting to pay for this cheap healthcare.

Remember, total Medicaid funding, Federal and State for healthy adults’ costs taxpayers about half what we spend on our health insurance coverage for our legislators. That’s because the Medicaid payments to hospitals and providers is so low.

Hospitals here in Idaho back in 2008 saw Medicaid payment cuts coming when the financial crisis sent us into recession. They suggested a solution, one many states had been doing for a while, but Idaho was slow to adopt.

“Tax us” they said. Hospitals suggested the state place a 10% tax to hospitals on every Medicaid dollar they received. This tax would then be used to spend on the states Medicaid payments to hospitals.

Why would they do that? Why would they want to pay back 10% of what they were paid, just to then have the state pay it back to them.

Here’s where the Ponzi aspect of this rears its head.

Back in 2008-2010, for every dollar the State of Idaho spent on Medicaid, the Federal government matched three. It’s currently dropped down to 2.5/1, but as you can see, we get back more than the tax takes.

Many states “assess” their hospitals at a higher rate. A few states don’t use this scheme at all. I use the term “assessment” , because that is what this is called in Idaho statute, an “assessment”.

But it’s a tax. Conservatives don’t like taxes, but assessments were just fine with the Idaho legislature.

Just like tariffs, which are taxes on us consumers, are tolerated as long as we can pretend that they aren’t a tax.

I have to admit, I didn’t like this when I found out about it in the legislature. Nursing homes pay an assessment too since they get Medicaid payments. But the hospital association said they couldn’t live without it, so I carried the renewal of this tax bill in the Idaho Senate. Makes sense, doesn’t it, an Idaho Democrat has to carry the tax bill most Republicans supported?

Written into this sleazy bill was an exception that also burned my gut. Private, for-profit hospitals lobbied to be excluded from this “assessment” and they got themselves written out of it. They claimed they didn’t get Medicaid payments. I looked into that. They were getting millions.

But congress wants to take this scheme away from states. In Idaho, we will lose about 10% of the Federal funding. For some states it’s almost a 40% cut.

There are only a couple ways to do this.

#1. Decrease enrollees = kick some folks off. The number of uninsured patients will climb, hospitals will still care for them, and they will get less money.

#2 Pay doctors and hospitals less for what they do. I’ve already told you Medicaid payment rates are the least of any payer. Hospitals cannot refuse to see Medicaid patients, but doctors can. Many already do. More will.

So, these are the choices we are making in this, our country. We enjoy the richest economy in the world. We spend by far the most per person (about 50% more than the next country spends) on healthcare of any country in the world. And we don’t have universal coverage. They do.

And we are about to send poor folks off coverage to provide somebody tax cuts.

Says something about our values, doesn’t it?

 

 

 

The Idaho legislature and our Governor (‘hi Brad!’) have decided Idaho would be best served by moving the billions of dollars we spend on Medicaid into a ‘managed care’ model. This is going to be an adventure. Keep in mind, Idaho is small potatoes.

We have almost the lowest costs per Medicaid patient in the country. But now we are going to negotiate some great deal with a managed care company to take over how these dollars are spent. They will see us as small, maybe even green potatoes.

So, we are going into this negotiation with our best minds and best data to review all the proposals in this $5B (that’s a billion) deal. That’s a THIRD of the total state budget.

Just what exactly do we want out of this? Government (meaning us taxpayers) is about to make some very wise (we hope) negotiation with some big (I mean VERY BIG) company about how our dollars should be spent on health care for the folks who can’t get work sponsored health insurance.

Do we have the data on how our current system is working? Do we have any idea if our Medicaid dollars are spent wisely? Do you, the Idaho citizen with employer provided health care have any idea if your health care dollars are spent wisely? I’m going to vote a “nay” on all those.

But we should be voting. And we should be voting on our healthcare. We don’t hear anything about healthcare from Trump or X or CNN.

The Idaho Freedom Foundation weighed in, good for them. They gave this bill a +3. That means all the folks you Idaho Republicans elected would vote for it to improve their scores and they would get reelected.

But the IFF had some reasonable criticisms. And some horse pucky. They had to struggle to get to their +3. Maybe somebody’s pulling their strings.

They did acknowledge that the data, the details once the contract is signed become proprietary. This only got one demerit.

Maybe we are all comfortable with this nowadays. Google knows what I search. Facebook knows my ‘friends’. Maybe that’s just the way we are going. Corporates own our data, and we are just pogues.

And they sell us more stuff. And sell our data. They get rich, and we keep working.

I find it hard to believe Idaho conservatives embraced this model. But the IFF did. And so did our elected representatives.

We can all shrug since it’s just Medicaid we are talking about here. Sorry. Look again. You folks with ‘real’ health insurance are also in this game.

Big companies decide based on the size of the potatoes.

Idaho has just about the lowest cost for private health insurance too. I already told you our Medicaid health insurance costs are at the bottom, remember? Don’t you feel like a small potato?

I’m sorry, but we should be a bit proud. We have no bloated bureaucratic institution controlling these costs. We just have good doctors, good hospitals, good communities.

I’ll admit here, I think we should have spent just a touch more on collecting the data and managing our providers. We could help them know the best ways to treat their patients. But fundamentally, health care providers in Idaho seem to be doing a pretty good job.

Sorry, I just want better.

But now all this effort in the Medicaid sector will be turned over to the lowest bidder. And they will get to keep some of our taxpayer dollars to reward their investors and CEO’s. Maybe your IRA will get a bump.

But will our state be healthier?

We will never know. We aren’t paying attention to that. We’re just fumbling along and voting like the IFF tells us to.

We are about to send state dollars out the door, and we may be no healthier for it. Thanks to you conservatives. Is this conservative?

 

All you Trump aficionados out there hailing DOGE chainsaw efforts need to give me a little help. I do know how to run a chainsaw and I respect a chainsaw.

The chainsaw analogy is overblown.

The excuse I am hearing for all this chainsaw wielding is “fraud and abuse”.

Excuse me if I roll my eyes right here. I have heard these claims in Idaho. Fraud and abuse.

Abuse is evil and bad, I agree, but fraud is a crime. Here’s the Idaho code. I’m sure there are federal codes for defrauding the federal government too. We have a State Attorney General. We have a US Attorney for Idaho.

If people are committing crimes against the rest of us, who pay taxes and follow the law, why the hell aren’t our elected prosecutors prosecuting them? Should we take a chain saw to these slackers?

Instead, we hear all these claims of ‘fraud and abuse’ and somehow think these fraud and abuse claims justify retribution. Is there something else behind these claims?

Let’s go to court.

Let’s sort this out.

At a recent Health and Welfare Board meeting we got told that a program supporting families caring for their disabled members at home would be discontinued. The Directors statement to us justifying this was because the Department had found evidence of ‘fraud and abuse’.

Now, don’t get me wrong. I do understand there are people out there who will abuse any system we build. People will steal water. People will park where they shouldn’t. People will litter. And we should shame them, even prosecute them.

But to shut down a program that has been helping families on the ‘fraud and abuse’ excuse tips me over.

Show me the fraud.

Prosecute it, damn it.

So, I asked our director at that board meeting 6 months ago, “Have there been any cases referred to the State Attorney General? Are we prosecuting this fraud?”

He deferred.

He will move on to serve a broader sphere. I have not read of any prosecutions by our Attorney General. Please, let me know.

Are we just using this ‘fraud and abuse’ smear as an excuse for the new age lynching of cutting off promised funds and employment?

We can do better.

People need to be honest. And they need to fear their dishonest behavior. I don’t mind making myself a prosecutor.

We have a place here in town to drop off yard waste instead of driving 5 miles out of town. It is a wonderful service. And it is abused.

I took a video of a commercial landscaper dumping his 5-yard trailer at the site and sent it to our mayor.

Last week I watched and scowled at people dumping on the pavement what they could have thrown their clippings in the bins.

If we make things easy for people, people abuse it.

Abuse is not fraud. Abuse deserves our approbation. Please feel free with me to look at, make eye contact with folks abusing the systems that are here to serve all of us. They deserve the shame.

But fraud is a crime. To lump it in with “abuse” is giving the prosecutors a free ride. Fraud means the perpetrator got money through their falsehoods. Fraud needs to be prosecuted.

DOGE is not prosecuting. DOGE is wielding a chainsaw.

Prosecution enforces the rule of law. Our government appointed law enforcers should prosecute those who take our taxpayer dollars through deceit.

We are on the cusp of turning this government ‘of the people, by the people, for the people’ into a government that now rewards those in power.

My glaring at abusers at our yard waste dump is not enough.

It will take more effort to show that we believe this republic is worth saving.

 

I have been on many teams. I have coached a few. When we all pull together, we can beat bigger foes.

The Idaho legislature is not a good team right now. They seem to be pulling against each other. Maybe that’s how democracy is supposed to work. Maybe it’s up to us to see the goal, work toward it, and win, for all of us.

This last session Idaho’s medical training of doctors (MD’s…there are other “doctors”) came under deep scrutiny. Idaho is involved with the University of Washington and other states to train MD’s. It’s the WWAMI program.

There were bills introduced to sever ties with UW. The final bill that passed, HB 368a, said we would stay in the partnership, but only provisionally.

UW and WWAMI are widely recognized for quality.

While the Idaho legislature was working to dump Idaho’s affiliation, the statistic they pointed to most often, and the one you’ll see on the social media feeds is that Idaho sits at the bottom for doctors per capita. The legislature seems to be wringing their hands about being at the bottom of the fifty states and the District of Columbia.

But only when it comes to our UW affiliation.

At the same time they cut proposed funding for doctors who might come here to serve underserved areas (most of Idaho).

And cut Medicaid physician payments.

And they have put a gun to the head of doctors caring for complicated pregnant women.

If the Idaho legislature truly wants more doctors in the state, they need to pull together.

I agree with my conservative colleagues, there must be something more going on behind the scenes.

Here we come to the nut. And that’s what makes a team or sends you screaming for the exit.

What in fact do we want?

If we want more doctors in Idaho, we could do lots to make that happen. Given the sum of their actions, I argue the legislature is not interested in more doctors. There must be some other teapot tempest they are wringing their hands about.

I’m honestly just guessing here about what the Idaho legislature wants.

We should just forget about them.

The real question is what do we here in Idaho want?

Do we want more doctors?

Do we want good access to healthcare?

Do we want healthy communities?

Take those three questions and prioritize them. For they don’t all mean the same thing.

Massachusetts has the most doctors per capita, threefold more than Idaho.

But it takes an average of 70 days to get in to see a doctor in Boston. That’s the worst of any area surveyed.

Further, Massachusetts only ranks as the 12th “healthiest” state in another survey. Idaho, with our paltry supply of physicians ranks 16th.

The data says, having more doctors doesn’t necessarily give one better access, or make healthier communities.

So why is the Idaho legislature suddenly all twisted shorts about the number of doctors?

Back when I was a young WAMI (1985), Idaho had 12.1 doctors/ 10,000 residents. We were comparable with Mississippi and Alabama.

We were a poor state, like them. Many doctors don’t want to work where the patients are poor. Don’t forget, medicine in this country is a business, and doctors are businessmen.

Now we are a tiny bit richer. And we have 17 doctors/10,000 people. We’ve come up.

I’m sorry about all these numbers. There’s really just one big take away.

More doctors doesn’t mean healthier people or better access.

If you want healthier, you will have to look bigger. I would argue a guy very important to our health might be sitting in our local water treatment plant.

If you want more doctors, you will also have to look bigger.

I am glad the Idaho legislature has decided they need a broader perspective. I hope we are all served.

 

April 15th is next week. Are you ready to pay your taxes?

I’m a pogue, so I pay what I’m told I owe. Are you a pogue too?

I learned the term ‘pogue’ when I was fighting fires for the US Forest Service.

Pogues do what they are told, even when they know better.

The slope is indefensible, and the fire is below, but we would dig and cut across. When the black smoke came up, we’d find shelter and survive. We knew the idiots who were directing us would too. But we’d get the GS 3 or 4 rate, time and a half or even time and three quarters with hazard pay. 60- or 80-hour weeks, it added up to a decent summer.

Pogues survive. And we pay our taxes.

Others might not.

Maybe that’s the difference between pogues and real people. We just shuffle along and take the measly wage they’ll pay us. Real people know the strings to pull.

Elon Musk is in the news a lot.

He gets to fire people right and left. Republicans love his sense of justice. If you aren’t doing worthwhile work, you’re done.

That line we cut above the fire would never hold. It was not worthwhile. It was destructive and wasteful. But us pogues did it. We survived and so did the idiots who told us to do the work. But, honestly, at times, we wanted to kill them.

Instead, we paid our taxes.

And it turns out, they probably didn’t.

Mr. Musk is the richest man in the world. Maybe that makes him the smartest. President Trump claims to be rich, so maybe he’s smart too.

But know this. Tesla, Musk’s company paid no taxes in 2024, even though they reported a $2.3B income.

Yeah, you can try to sell your CO2 planet saving car, but can you really try to change this mess?

This taxation thing is rigged.

Republicans claim only the rich pay taxes and the rest of us are government sucking pogues. I’m sorry. I’m writing a big check to the IRS this coming week. And it seems Elon may not be.