Letter: Medicaid

Thanks for reprinting on April 7 the Lewiston Tribune editorial about Medicaid expansion.

In refusing to extend Medicaid coverage to the poor under the Affordable Care Act, and save Idaho taxpayers $90 million or so per year, Gov. Butch Otter and the Legislature demonstrate their political depravity.

Political campaigns are being

fueled with foam-at-the-mouth

anti-Obamacare. After the vote is in, Otter and legislators will fabricate an excuse to embrace expanded Medicaid and those lovely federal dollars the moocher State of Idaho loves to hate.

In the meantime, some sick Idahoans will get sicker and some will die. Idaho taxpayers will pay another $90 million or so for Obama. Ho-hum. It’s just normal Republican political collateral damage.

Ed Chaney, Eagle

Maine Democrats’ final attempt to expand Medicaid

— Maine lawmakers have endorsed a final attempt by Democrats this session to expand health care coverage to more than 70,000 low-income residents.

Under the new proposal, the state would expand Medicaid coverage for one year while seeking a waiver from the federal government.

With a waiver, the state could use the funds to cover roughly 55,000 people in private plans on the federal exchange. Another 15,000 people would remain in the Medicaid program.

The Democratic-led House voted 95-52 for the bill Thursday. The Senate followed with a 19-14 vote. But the support falls short of the two-thirds majority the bill would need to survive a near-certain veto from Republican Gov. Paul LePage.

The bill now faces final votes in both chambers.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP’s earlier story is below.

As Maine lawmakers near the end of their session, they are returning Thursday to a familiar debate: whether to accept federal dollars to provide health care coverage to about 70,000 low-income people under the Affordable Care Act or accept the governor’s contention that expansion would be too costly for the state.

The Democratic-controlled Legislature is poised to consider a new plan introduced by House Speaker Mark Eves, of North Berwick, under which the state would use the federal Medicaid funds to purchase private health insurance for low-income residents.

Under the proposal, the state would expand Medicaid to the eligible population for one year while requesting a waiver from the federal government. If successful, Maine would use the Medicaid funds to cover roughly 55,000 people in private plans on the federal exchange, or marketplace. Another 15,000 would remain in the Medicaid program.

If the federal government denies the waiver request, Medicaid coverage for all 70,000 would end next year, Eves said.

Eves said Thursday that his proposal is a final attempt to compromise and ensure that residents get the health care coverage they need.

“I cannot leave this building without knowing that we did everything that we could to insure 70,000 Mainers with life-saving health care,” he said.

Democrats have failed three times to muster enough support from Republican lawmakers to overturn Gov. Paul LePage’s repeated rejection of Medicaid expansion proposals. Many GOP lawmakers agree with LePage that the expansion would be too costly.

On Thursday, LePage called the latest proposal a political ploy and accused Democrats of waiting until the last minute to bring the measure forward to “try to pull the wool over everybody’s eyes.”

“It’s disturbing that liberal leadership refuses to listen to the people of Maine when they say they want real welfare reform,” he said in a statement. “Instead, liberals push policies that will cost Maine taxpayers millions of dollars and put the state deeper into debt.”

Arkansas has already received federal approval for the so-called “private option” as an alternative to expanding Medicaid under the federal health care law. New Hampshire Gov. Maggie Hassan, a Democrat, recently signed a similar proposal.

The bill is among several lawmakers are considering as they attempt to finish their work for the session. They plan to adjourn this week and then return in early May to vote on any bills that LePage may veto before the session officially comes to a close.

Follow Alanna Durkin on Twitter at http://www.twitter.com/aedurkin

Garden City man sentenced for neglect, abuse, Medicaid fraud

A man from Garden City who pleaded guilty to abuse, neglect and Medicaid fraud has been sent to a sober-living house.

Paul J. Draine, 43, was sentenced Thursday for neglecting his mother and submitting claims to Medicaid for fraudulent services, according to Attorney General Lawrence Wasden. Fourth District Judge Lynn Norton sentenced Draine to a prison sentence — one year fixed and four years indeterminate. But the court suspended the prison sentence and ordered Draine to enter the Rising Sun Sober Living facility in Boise.

Draine will be on supervised probation for five years and must pay $23,408 in restitution to the Idaho Department of Health and Welfare, Division of Medicaid, Medicare and a private insurance company.

Draine pleaded guilty March 20 to one felony count of abuse or neglect of a vulnerable adult and one felony count of provider fraud. By pleading guilty, he admitted that while employed by TLC Home Health Care & Nursing Inc., he neglected his mother’s care. She was admitted to a Saint Alphonsus Health System hospital severely dehydrated and malnourished, Wasden said. Hospital medical staff contacted Adult Protection Services because they suspected she was a victim of abuse and/or neglect, Wasden said.

A family member reported the situation to the Medicaid Fraud Control Unit of the Office of the Attorney General. Adult Protection Services helped the unit with its investigation. Investigators from the Medicaid Fraud Control Unit and the Garden City Police found the home — which Draine shared with his elderly parents — filthy with drug paraphernalia, trash and dog feces among piles of clutter, Wasden said.

GOP budget slashes spending, aid to poor

— A budget plan stuffed with familiar proposals to cut across a wide swath of the federal budget got a vote of confidence from the House GOP’s top vote counter Wednesday and was steaming through the Budget Committee. Democrats assaulted its sharp cuts to health care coverage for the middle class and the poor, food stamps and popular domestic programs like highway construction, health research and education.

The GOP-controlled committee was on track to approve the plan Wednesday night after a partisan but civil debate. The plan by Rep. Paul Ryan, R-Wis., the committee chairman and the party’s former vice presidential nominee, promises $5.1 trillion in cuts over the coming decade to help bring the government’s ledger into the black by 2024.

The plan is a nonstarter with the Democratic Senate and President Barack Obama, but gives Republicans a vehicle to polish their budget-cutting credentials in the run-up to fall midterm elections in which they’re counting on a big turnout from GOP conservatives and the tea party.

Ryan’s plan would wrestle the government’s chronic deficits under control after a decade, relying on deep cuts to Medicaid, highway construction, federal employee pension benefits, food and heating aid to the poor, and Pell Grants for college students from low-income families. It would eliminate health care coverage under the Affordable Care Act while assuming the government keeps $1 trillion worth of Obamacare’s tax increases, and retains a 10-year, $700 billion cut to Medicare that Democrats drove through in 2010 when passing the health care law.

Republicans say such tough cuts are required to take on chronic deficits that threaten to sap the economy of its strength in coming years as government borrowing squeezes out savings and investment and spiraling costs of federal retirement and health care programs promise to swamp taxpayers. Ryan cited Congressional Budget Office studies that show curbing deficits and debt would lead to a healthier economy in the long term — and claims $74 billion in such macroeconomic effects to promise a balanced budget in 2024.

“Just as a weak economy can drag the budget into the red, a responsible budget can help propel the economy forward,” Ryan said. “If Washington is serious about helping working families — or serious about getting families out of work back to work — then it needs to get serious about the national debt.”

But Democrats cast Ryan’s plan as an all-out assault on the poor and working class. More than $700 billion in cuts to Medicaid over 10 years would force hundreds of thousands of seniors from nursing home care, for instance, while $135 billion cut from food stamps and other nutrition aid would increase hunger. Eliminating a mandatory funding stream for Pell Grants would mean fewer poor kids could dream of college, they said, while cuts to education, scientific research and NASA would harm U.S. competitiveness.

“This dog-eat-dog budget is nothing short of an assault on Americans struggling to stay afloat economically. It absolutely decimates safety net programs — like (food stamps) and Medicaid — designed to stop people from falling into deep poverty,” said Maryland Rep. Chris Van Hollen, the top Democrat on the budget panel.

A top GOP leader promised Wednesday that the Ryan budget would pass the House next week despite resistance from conservatives uneasy over higher spending for agency budgets in 2015, in line with a small-bore budget pact negotiated in December by Ryan and the head of the Senate Budget Committee, Sen. Patty Murray, D-Wash., in December.

“It’ll pass,” promised Rep. Kevin McCarthy of California, the party’s chief vote-counter.

Under Congress’ arcane budgeting rules, the annual budget resolution is a non-binding blueprint that tries to set broad goals for follow-up legislation on taxes, agency spending and curbs on the growth of expensive benefit programs like Medicare, whose budgets go up every year as if on autopilot.

As such, the annual budget debate allows GOP lawmakers to go on record in favor of spending cuts big and small — whether it’s slashing Medicaid, cutting subsidies for farmers and Amtrak, or further cuts to the day-to-day operating budgets of domestic agencies like the Transportation Security Administration — without having to follow through with binding legislation.

So every spring, the House goes on record to eliminate taxpayer subsidies for money-losing flights into rural airports and community development grants to state and local governments, for example, only to have GOP appropriators scramble to replace them later on when adopting a binding spending bill.

Ryan’s budget brings back a now-familiar list of spending cuts: $2.1 trillion over 10 years in health care subsidies and coverage under the Affordable Care Act; $732 billion in cuts to Medicaid and other health care programs; almost $1 trillion in cuts to other benefit programs like food stamps, Pell Grants and farm subsidies. At least $500 billion in cuts over 10 years to so-called mandatory programs besides Medicare, Medicaid, food stamps and Social Security are not identified at all, but are likely to include cuts to refundable tax credits for the working poor and workers with children and benefits under the Supplemental Security Income program, which directs aid to the disabled and very poor elderly people.

While repealing “Obamacare’s” benefits, the GOP plan relies on its tax increases and cuts to providers to promise balance, including reductions to private insurers under the Medicare Advantage program. Republicans have attacked Democrats for the Medicare cuts used to finance the health law.

Letter to the editor: Medicaid expansion

Gov. Butch Otter appointed a work group July 2012 to evaluate expanding Medicaid to Idaho working poor. At a cost of $195,000 his appointees delivered the governor’s report, December 2012 with the recommendation: The committee universally supports expanding Medicaid coverage to the working poor. They also stated that improved health status and reduced mortality would result. Although not stating that 590 Idaho citizen lives per year would be saved, this is the number that results from their reference to the September 2013 New England Journal of Medicine. In response to the governor’s question “Is expanding Medicaid in the financial best interests of Idaho?” the report states:

• It appears to be very advantageous financially for the state. Taxpayers will save significant state and county funds.

• There will be financial benefits to hospitals, medical providers and community health centers.

• Out of state businesses will look favorably at locating to Idaho.

• Tax benefit to Idaho is estimated at $615.6 million, 2014 to 2014.

Plus, 5,900 lives will be saved and potentially 16,000 new jobs created.

The governor decided January 2014 not to put the recommendation of his own report, to the Legislature. Let’s elect a true pro-life leader for Idaho.


McAuliffe travels Va. touting Medicaid expansion

— In his first months on the job, Virginia Gov. Terry McAullife is trying to capitalize on Democrats’ takeover of top state offices and the state Senate by pushing a key element of President Barack Obama’s health care law through a Republican-dominated House of Delegates.

The General Assembly’s regular session ended a week ago without an agreement on expanding Medicaid, leaving the matter to be resolved with the rest of the state budget at a special session at the end of March. Now McAuliffe is drawing on his past as a rock-star fundraiser by barnstorming cash-strapped hospitals to pressure the House to accept billions in federal money to insure the poor.

If the two sides can’t agree on a two-year budget by the end of June, state government would shut down. McAuliffe has rejected Republican calls to pass the $96 billion budget without expanding Medicaid and revisit the subject in another special session.

Earlier this month McAuliffe visited a hospital and health clinic in southwest Virginia in an effort to highlight how struggling hospitals in poorer, less populated areas desperately need the federal cash. The former head of the Democratic National Committee and Clinton confidante — who once wrestled an alligator for campaign cash — appeared at ease while meeting with patients and hospital officials in a county that McAuliffe lost to his Republican opponent by nearly 45 points in last year’s election.

“We see everyday patients that are actually dying,” said Paula Hill Meade, clinical director at the Health Wagon free clinic. “It’s either eat or buy their medicines.”

Meade says the clinic has seen a 70 percent increase in the number of clients in the last year as the area economy has suffered from problems in the coal industry.

After meeting with two patients, the governor raised his voice and slammed his hand on a table for emphasis.

“I wish your delegate and senator would come here and look you in the eye, and explain to me why we’re not giving them health coverage,” McAuliffe said.

The Republicans who control the state’s House of Delegates oppose expanding Medicaid and argue that states would have to foot the bill if the federal government doesn’t keep its funding promise. The Obama administration has pledged to pay for the first three years of expansion and no less than 90 percent after that.

About half the states have decided to expand Medicaid, and several others are still considering an expansion. While a handful of states with Republican governors are expanding, most southern states have declined to do so.

The election of McAuliffe and a Democratic lieutenant governor armed with a deciding Senate vote gave supporters of Medicaid expansion hope that it could happen this year. But McAuliffe had little luck finding a deal before the end of the regular session.

If McAuliffe were able to swing one of the largest states in the South, it not only be a symbolic victory for the Obama administration but would also show there are ways for states with divided governments to “get to ‘yes,’” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, which advocates for low-income people.

Virginia, which has a long history of resisting public assistance, ranked 48th in per capita Medicaid spending last year, according to state figures.

But McAuliffe is confident that the state, which also elected a Democratic attorney general last year, is ready to break from its conservative legacy.

“This is too much money,” said McAuliffe, adding that a state budget estimate projects the Affordable Care Act with expanded Medicaid for 400,000 residents would save Virginia $1 billion by 2022.

The current plan being pushed by Virginia Senate Democrats and three Senate Republicans would expand Virginia’s current use of private insurers to Medicaid clients. Similar approaches have been used elsewhere, such as Arkansas, to make expansion palatable to Republicans.

But House Republicans have rejected that plan. They have also said that increased Medicaid spending wouldn’t cure all of rural hospitals’ many budget woes, and note that their proposed budget would increase payments to free health clinics.

Republican Del. Terry Kilgore, whose district includes the Health Wagon clinic, said most messages from his constituents following McAuliffe’s visit were against a Medicaid expansion.

“Other than from the hospitals, I’m not getting a cry and hue from my constituents to expand Medicaid,” said Kilgore.

Larry J. Sabato, director of the University of Virginia Center for Politics, said he doubts Republicans, wary of facing primary challengers from their right flank, will hand McAuliffe a win.

The new governor is a millionaire former Democratic National Committee chairman who was co-chairman of Bill Clinton’s presidential campaign and Hillary Rodham Clinton’s 2008 campaign.

During the legislative session, the former D.C. power player tried to woo lawmakers with frequent receptions at the Executive Mansion, but has said Republicans simply aren’t interested in negotiating.

Republicans, in turn, have said that McAuliffe isn’t interested in having a serious debate. They have also pointed out that some of the hospitals McAuliffe has visited enjoy comfortable profit margins and have generous pay for top executives.

“The whole world is upside down, they’re attacking CEO pay,” said McAuliffe in an interview with The Associated Press aboard a state-owned plane flying back from Wise County.

McAuliffe had said he has more trips planned and expects Republican lawmakers to feel pressure from their constituents.

Before leaving the clinic in Wise County, McAuliffe made a promise to Pat Beverly, a grocery store cashier who said she can’t afford health insurance.

“I’m going to get this done for you,” McAuliffe said. “If it’s the last thing I do.”

Afterwards, Beverly told a reporter that she and her husband make about $2,000 a month, which could put them slightly above the cut-off line for Medicaid expansion.

Regardless, Beverly, who said she’s good at reading people, said she had her doubts about McAuliffe’s pledge.

“Right now I’m reading that it’s just a big show,” she said.

Lawmakers seek agreement on medical clinic grants

— The Mississippi House and Senate will attempt to work out their differences on a proposal to expand state subsidies to health clinics.

The efforts, proposed by Gov. Phil Bryant, are meant as a partial alternative to expanding the Medicaid insurance program for poorer people.

The House passed an amended version of Senate Bill 2117 Thursday. House Public Health and Human Services Committee Chairman Sam Mims, R-Natchez, said the two chambers will confer to work out differences.

Under the health care overhaul President Barack Obama signed into law in 2010, states may provide Medicaid to people making as much as 138 percent of the federal poverty level, about $15,000 a year for one person. In Mississippi now, the income cutoff is about $5,500 for one person, and many able-bodied adults are not eligible for Medicaid coverage regardless of how little they earn.

Mississippi is among about two dozen states that have rejected the expansion. Bryant and Republican leaders of the Mississippi House and Senate say they don’t trust promises of federal funding and Mississippi can’t afford possible future costs. Part of Bryant’s alternative is to give money to health clinics.

“These clinics successfully help patients manage and control chronic illnesses, and they are adept at achieving cost savings through quality monitoring,” Bryant’s budget proposal stated.

Supporters of Medicaid expansion say that’s not enough.

“The governor’s proposal is not a long-term strategy that seriously addresses the needs of the community health centers or the needs of Mississippi’s uninsured working families,” Roy Mitchell, executive director of the Mississippi Health Advocacy Program, said in a statement. “As the state continues to reject Medicaid expansion, Mississippi’s community health centers stand to lose $19 million in new revenue annually.”

In his 2013 budget, Bryant recommended spending $8 million, with $4.8 million going to expand the state’s existing network of community health centers, which treat many patients without insurance or who have lower incomes. That money would help the clinics expand hours or set up additional satellite locations.

Bryant also wanted $3.2 million to create new community health centers or help existing clinics become federally certified.

The House chose to adopt the first prong, allotting $4 million to underwrite expanded operations for an existing set of federally-qualified or nonprofit rural clinics.

The Senate, though, chose the second prong, which would open the grant program to any health care provider that cares for patients in an underserved area.

Follow Jeff Amy at http://twitter.com/jeffamy

Wyoming governor opposes Medicaid expansion

— Gov. Matt Mead is recommending that the Wyoming Legislature not accept federal money to expand Medicaid coverage to more than 16,000 low-income adults who lack health insurance.

Mead, a Republican, said Friday he can’t see plunging Wyoming deeper into working with the federal government on implementation of the new federal health care law given the serious problems with its rollout so far.

Expansion of Medicaid to cover the uninsured is a cornerstone of President Barack Obama’s Affordable Care Act.

Some Wyoming Democrats, however, said they’re hopeful they can work out an agreement in the legislative session that starts in February that would allow the state to accept federal money to expand Medicaid. They argue the state can’t afford to turn its back on potentially hundreds of millions in federal subsidies over coming years.

Implementation of Obama’s signature health care reform law has been plagued by problems in recent weeks.

The federal registration website was supposed to provide a place for people to shop for approved insurance programs and apply for federal assistance to help cover the cost. Technical problems became apparent as soon as it went online in early October, and many people have not been able to register.

The Obama administration has been forced to postpone key elements of the new law even as deadlines loom for getting approved insurance coverage by early next year.

Insurance companies notified customers that coverage that didn’t meet new federal requirements would be canceled, but problems with the new system have forced the federal government to reverse itself and say companies can continue offering the old policies for a time.

Mead addressed reporters Friday by telephone from Dubai. He and first lady Carol Mead spent Thanksgiving in the Middle East visiting with troops deployed there from Wyoming.

“The problem that I see with the ACA is that in large part it presumes that the exchange is going to work,” Mead said.

“We were going to get people into the exchange, a lot of young, healthy people into the exchange, and in doing that you’re going to ultimately cut costs for everyone,” Mead said. “And when you see the exchange, in my view, doing more to kick people off of insurance instead of putting them on, sort of the whole notion, the whole pretext of how this is going to work is in doubt.”

Mead is a long-time opponent of the Affordable Care Act. He steered the state into joining a multi-state challenge of the constitutionality of the law. The U.S. Supreme Court ultimately ruled that the law passed muster.

Mead said Friday he will continue to evaluate the law and how it’s implemented. He said that if it ever appears advantageous for the state to expand Medicaid, he would support doing so.

The Legislature last year voted against accepting $50 million in federal money to expand Medicaid despite federal promises to foot most of the future cost.

As of early this year, the Medicaid program was serving over 77,000 people in Wyoming at an annual cost of over $500 million, split evenly between the state and federal governments. Tom Forslund, director of the Wyoming Department of Health, has said expanding the Medicaid program in Wyoming would save money by getting people off of other programs.

Rep. Ken Esquibel, D-Cheyenne, said Friday he believes accepting the optional Medicaid expansion would save Wyoming money. He said uncompensated trauma care costs hospitals in the state roughly $200 million a year.

“It makes sense financially to cover that population of citizens who are not going to be available to be covered under any other type of health care coverage,” Esquibel said.

“It seems to be more a political move on the part of the governor, than a common sense move on the part of the governor,” Esquibel said.

Senate Minority Floor Leader Chris Rothfuss, D-Laramie, said Friday he’s hopeful the Legislature can reach a compromise to expand the program.

“We are going to pay for that health care, it’s just a question of how we go about it,” Rothfuss said. He said the state can choose to do it through expanding Medicaid or by informally allowing uninsured people to continue to use emergency care without any access to preventative medicine.

“At the same time, if you’re pragmatic about it, it’s an awful lot of money that the state of Wyoming will be turning down if we continue to resist the option Medicaid expansion,” Rothfuss said. “The estimates I’ve seen indicate that it’s around $750 million over the next seven years that we would have access to.”

David Adler: Idaho should adopt Ohio’s stance on Medicaid

In words that have reverberated across the American political landscape and sharply challenged GOP opposition to the expansion of Medicaid, Ohio Gov. John Kasich warned fellow Republicans to halt their “war on the poor.”

Kasich circumvented his obstinate legislature and declared, for reasons of fiscal responsibility and compassionate conservatism, that the Buckeye State would embrace Medicaid expansion offered under the Affordable Care Act, providing health care coverage to nearly 300,000 Ohioans.

Was his message heard in the Idaho State Capitol?

In terms that appealed to social conservatives and voters of faith including, perhaps, those in Idaho who purport to embrace “family values,” Gov. Kasich, a potential standard-bearer for the Republicans in the 2016 presidential election, shared a New Testament homily with listeners: When you arrive at the Pearly Gates, St. Peter may not ask “what you did to make government small, but he surely will ask what you did for the poor.”

A Daniel come to judgment, Gov. Kasich, a former ax-wielding chairman of the House Budget Committee, denounced the cruel stereotype that the poor are “shiftless and lazy.” Some simply can’t help it, Kasich explained. He said that those who complain about those on the lists of the unemployed should ask themselves if “their grandparents worked for the WPA,” the Depression-era program that employed millions of Americans.

Last year, Gov. Butch Otter rejected the idea of extending Medicaid health care coverage to more poor residents of Idaho. His decision ignored a unanimous recommendation from the commission that he appointed to study the desirability and financial implications of the expansion program. At the end of the legislative session in late March, House Speaker Scott Bedke, R-Oakley, determined that there wasn’t enough time to consider the idea of adopting Medicaid expansion.

This time around, however, there will be more than enough time to consider and adopt a program that would provide coverage for some 100,000 Idahoans and save the Gem State and Idaho counties some very serious money. According to an analysis conducted by the Urban Institute and the Henry J. Kaiser Family Foundation, as reported by The Associated Press, Idaho would spend an additional $261 million from 2013 to 2022 to cover new enrollees through Medicaid expansion, and the federal government would send some $3.7 billion to Idaho.

Setting aside the moral strength of the argument for providing health insurance coverage and improving the quality of life for Idaho’s poor, and assessing the adoption of the program from purely a financial perspective, can Idaho find a better investment?

Adoption of Medicaid expansion would result in additional savings. States that embrace the expansion can save on health care costs for prison inmates. From 2001 to 2008, Idaho saw a 24 percent increase in its health care costs for inmates, according to a Pew Charitable Trust report that relied on figures from the Federal Bureau of Justice Statistics. An aging prison population will lead to increased costs.

In the wake of Kasich’s announcement, word is spreading that additional “red” states are considering adoption of Medicaid expansion. It’s a smart business move for legislators who subscribe to fiscal conservatism. It’s an effective means of curbing costs to counties that bear the expense of indigent health problems. It’s an effective means of saving taxpayer dollars. Best of all, it is an exercise in compassionate conservatism, an attractive bumper-sticker advertisement awaiting implementation.

Let us hope Gov. Otter and Idaho’s legislators have heard Gov. Kasich’s words. Let us hope that they are followed.

David Adler is the Cecil D. Andrus professor of public affairs at Boise State University, where he serves as director of the Andrus Center for Public Policy.

Reader’s View: Idaho needs to figure out how to help all of its citizens

We’ve all heard the swirling debate over health care — you can’t miss it over the airwaves or in your newspaper. But let’s focus on Idaho, and what our state can gain or stands to lose in the coming year.

It’s Mental Health Awareness Week (Oct. 6-12); however, mental illness is only a part of the health care problem. There are 80,000 Idahoans, mostly working families, who don’t earn enough to qualify for the subsidies to purchase policies in the new insurance exchanges. That is a large gap as reported by the governor’s work group last year. It makes Medicaid redesign worth doing.

Earlier diagnosis for both mental and physical illnesses when one has covered doctor visits would improve quality of life and longevity. First visits for a condition would not take place in the ER, but rather with the family doctor. People living with mental illness die in their 50s, on average, from treatable medical conditions. Dental benefits for this group could be restored so dental abscesses leading to hospitalization and even some reported deaths would not occur. Healthier adults are more productive and valuable employees.

The financial benefit to the state if we redesign Medicaid to include these citizens is huge, and has been thoroughly researched and reported to the Legislature. State Catastrophic Assistance and counties’ Indigent Fund, which spent over $50 million in 2011 and $70 million in 2012, would become mostly unnecessary as replaced by federal dollars. Our local tax dollars could be better spent elsewhere. If we don’t join the states who have accepted Medicaid for those in the gap, we leave over $40 million of yearly federal funds on the table, and our people uninsured.

The Department of Health and Welfare cut $6 million from annual mental health funding during the past recession. Treatment was only for those in crisis or jail, and there was not enough left for earlier treatment or adequate recovery support. Funds have still not been restored. Statistics from 2010 place Idaho 51st in mental health spending per capita. Children’s mental health funding was so poor, parents were advised to have their teenagers get arrested to get access to allocated prison funds for mental health.

Our elected representatives work very hard to allocate available dollars among all the pressing needs before them, and have to make difficult choices every session. The financial relief offered to the state budget by accepting Medicaid redesign would allow them some breathing room, and programs cut could be restored.

There are a few bright spots on the horizon. The new suicide hotline has been successfully up and running for a full year. The Suicide Prevention Action Network is rolling out a program for primary care physicians to help them recognize and obtain resources for a patient in need of mental health services. Law enforcement officers and first responders all over the state have completed training in crisis intervention for people exhibiting symptoms of mental illness. A new managed care company with a focus on recovery, Optum Idaho, has begun managing the Medicaid Behavioral Health program.

Do we want to pass up this opportunity and keep Idaho at the bottom in national health rankings, and sixth in the nation in suicides?

If you see value in helping the 80,000 obtain health coverage, please let your elected representatives know. They need to hear from you that you support Medicaid redesign, and that it’s time Idaho does the right thing for all of its people.

Kathy Mercer, R.N., of Meridian, is an Idaho state board member of National Alliance on Mental Illness (NAMI).