Obamacare ruling results in health exchange, Medicaid decisions for legislative candidates

Obamacare ruling results in health exchange, Medicaid decisions for legislative candidates

by
Mitch Coffman
October 24, 2012
Mitch Coffman
October 24, 2012

Note: This is the second of a three-part series on responses to a survey sent to general election candidates. On Tuesday, the series looked at education-related issues including Propositions 1, 2 and 3 and funding for K-12 and higher education. Thursday IdahoReporter.com will wrap it up with a look at privatizing liquor, “sin” taxes, online sales tax and the personal property tax.

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The Patient Protection and Affordable Care Act, commonly referred to as Obamacare, was ruled constitutional by the U.S. Supreme Court in June. States now must decide whether to implement a state health exchange or default to a federal health exchange, as well as whether or not to expand their Medicaid programs.

In Idaho, three task forces have been looking into the issues regarding both the health exchange and the expansion of Medicaid, with recommendations due to the governor in November.

The Idaho Freedom Foundation asked candidates several health-related questions, including how they feel about creating a state health exchange, expanding Medicaid, Department of Health and Welfare spending and selling insurance across state lines.

Health insurance exchange

Candidates were asked if they supported defaulting to a federally run exchange, supporting a state-run exchange, supporting a state-federal partnership that allows the state to run some portions of the exchange or if they were undecided.

Out of the 53 responses, 15 supported defaulting to a federal exchange, 17 supported a state-run exchange, three supported a state-federal partnership and 18 were undecided.

Democrat Erin Zaleski, running for House Seat B in District 21, supports a state-run exchange because it can protect consumers. “I believe we need to have our own health insurance exchange. It's a way we can protect consumers from fraud or discrimination.”

Brad Bolicek, a Republican running for House Seat B in District 18, believes defaulting to the federal exchange is the best course for the state. “The default Fed program is in effect a choice to have no government-run health exchange, since the Feds will not be able to pay for the program in dozens of states. Congress will not fund the program.”

Running as an incumbent for House Seat B in District 14, Rep. Reed DeMourdant, R-Eagle, supports a state-federal partnership for the exchange because, to him, it doesn’t really matter who runs it because the exchange doesn’t address the real issue with health care.

“Unfortunately, all this discussion of the exchange does nothing to address the real issue, namely the cost of health care.  We have become distracted by this exchange discussion and we need to get back to discussing ways to bring down the cost of health care,” he says. “The exchange is essentially an electronic supermarket to help dispense government subsidies for those that don’t have insurance. As a result, it really does not matter who runs the exchange because both the federal government and state government are equally good at giving away money.”

Speaker of the House Lawerence Denney, R-Midvale, running for House Seat A in District 9, was undecided only because he doesn’t support either a federal exchange or a state exchange. “I don't support a federally run exchange or a state-run exchange that the federal government tells us how to run. I prefer market-based solutions to the health care issue.”

Medicaid expansion

Candidates were also asked about the possible expansion of the Medicaid program in Idaho. The results were much more one-sided on this question compared to the exchange. Five candidates supported the expansion, 35 opposed it and 13 were undecided.

Ralph Mossman, a Democrat, is running for House Seat B in District 32. He supports the Medicaid expansion in Idaho, feeling not expanding Medicaid would put the burden on the counties. “I don't believe that abandoning the poor and disabled is the right thing to do. County medical indigent funds are already being used up and counties don't need the additional burden. We are the wealthiest country in the world and should be able to take care of those who need it most.”

Libertarian Christopher Brunt, running for House Seat A in District 33, is opposed to the expansion of the program and believes health care should not be run by the federal government. “It does no one in the state of Idaho any benefit to increase a federally funded insurance program when the actual issue of cost of health care will continue to go unaddressed. The real problem is the abusive billing practices of health care providers and the lack of state regulation on those billing practices. As long as individual health care providers can charge whatever they feel like charging the people of Idaho without regard or respect to each individual Idahoan's paycheck and overall ability to pay for essential health care, there will be no solution to this problem.”

Brant adds, “We must keep health insurance voluntary and therefore competitive while opening up voluntary access to health insurance across state lines. We must also enact legislation to cap health care costs here in Idaho relative to each individual Idahoan's earnings. Finally, we must expand the mandatory health care provider law which exists currently in Idaho emergency rooms to cover any health care practitioner who provides life-essential health care services.”

Rep. Marv Hagedorn, R-Meridian, now running for state senator in District 14, is undecided about the expansion of the program, but currently sees no reason for it to expand. “Idaho Medicaid was expanded due to the changes in the eligibility for the program regulated by the new law. This will cost us (an estimated) $32 million more per year. The decision to further expand Medicaid is now being studied to see if in the long term there is advantage for Idaho. I don't know the outcome of that study, but I don't currently see any reason for expansion.”

Selling insurance across state lines

During the 2012 legislative session, House Bill 587 was introduced that would allow Idahoans to purchase insurance across state lines. The bill passed the House, but never got a hearing in the Senate.

A 1961 law in Idaho prohibits purchase or sale of health insurance across state lines.

Candidates were asked if they would support legislation permitting the purchase of health insurance across state lines. Candidates overwhelmingly supported the idea of allowing individuals to purchase health insurance from any state with 43 supporting it, two opposed it and eight were undecided.

Republican Gresham Bouma, running for state senator in District 5, said, “Customers should be able to purchase coverage from any legitimate insurance company, and be free to choose what sort of treatments they would buy coverage for. Personal choice and responsibility need to be rewarded, which would occur in a free market in medical insurance.”

Sen. John Goedde, R-Coeur d’Alene, running for another term in District 4, said he would oppose the legislation. “Idaho has 740 companies licensed to do business in the state now. Adding companies may not increase competition and it certainly limits consumer protection.”

Running for state senator from District 12, Republican Todd Lakey said he favors free markets but wants more information on this issue. “I generally support a free market environment so I am inclined to allow purchase across state lines. However, I need more information on why current limitations exist and the impacts of making a change.”

Department of Health and Welfare spending

In 2012, the state Department of Health and Welfare made up 37 percent of the total state appropriation, the largest of any state agency. Candidates were asked what action the Legislature should take concerning the department’s spending: greatly decrease, slightly increase, keep the level the same, increase based on increased enrollment, slightly increase, greatly increase and undecided.

Answers were spread across the board, but the majority believed at least some decrease in spending was best. Eight believed the spending should greatly decrease, 21 believed it should slightly decrease, 10 thought it should stay the same, two wanted to increase it based on enrollment, three believed in a slight increase and nine were undecided. Not one candidate believed the spending for the department should be greatly increased.

Republican Lee Heider is running for state senator in District 24. He is one of those supporting a decrease in spending. “We cannot afford any increases at this time. We need to reduce the dependence of people on welfare.”

Rep. Darrell Bolz, R-Caldwell, is seeking another term for House Seat B in District 10. He says he is unsure about spending levels in the department for several reasons. “Food stamps (SNIP) is funded by the federal government, the state only manages the program. All programs, including H & W, need to be scrutinized for efficiency and effectiveness. I have always felt that those who are on benefits should do something in order to receive the benefits. The more we hand out, the more reliance is on handing out more. Funding of H & W is predicated to a large extent on Medicaid funding match rate. General fund dollars vary according to this match rate.”

Democrat Mossman is in favor of slightly increasing spending in the department, but said the issue is complex. “This is complicated because there is abuse of the system as well as need. Separating the two is important, but reducing funding may not solve that problem. We may need to put more into better management upfront in order to reduce abuse and save money and get those who can work, back to work.”

Note: IdahoReporter.com is published by the Idaho Freedom Foundation.

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