Instead of focusing on how he might promote conservative ideas, such as tax relief, Gov. Butch Otter used a press conference Thursday to announce that he’d ask lawmakers to create a $30 million government entitlement program. The entitlement program would provide medical services to people who don’t qualify for Medicaid or Obamacare insurance subsidies.
Otter’s announcement is bad. His proposal is a government entitlement, something for which Otter has experience. In 2003, as a congressman, Otter planned to vote against a Republican Medicare expansion plan. Otter held out, until his arm was twisted to support the proposal, guaranteeing its passage. This time, no one is twisting Otter’s arm. This proposed entitlement program is a creature of his and his administration’s creation.
Otter’s plan calls for medical providers to receive $32 per patient per month to provide primary health care services to about 78,000 people below the federal poverty line. The money would come entirely from state taxpayers; patients would be required to kick in some money, too, on an income-based sliding scale. According to an Idaho Department of Health and Welfare fact sheet, patients could stay on the program indefinitely.
The Otter proposal provides a formulaic approach to health care, declaring that every patient in every part of the state needs the same kind of services rendered through what’s called a medical home. And it requires those medical homes to provide a level of primary care treatment dictated by politicians and bureaucrats in Boise.
The plan doesn’t put an end to Idaho’s county-state single-payer program for indigent care. The proposal contains nothing that would let communities invest in their own creative solutions for providing health care services to people in need. It is also silent about the need to help lift people out of poverty and become less reliant on government services.
Otter’s proposal should fail to gain traction with lawmakers who really do believe in limited government and who believe that solutions should come from the community and not from lawmakers and state agencies. The proposal should fail with lawmakers who don’t want to create a government entitlement. I suspect it will not gain favor with liberal legislators who just want a check from the federal government for Medicaid expansion.
As I’ve opined before, there is a conservative way to provide health care services to people who need it, temporarily, and with very limited involvement of politicians, bureaucrats and agencies. It requires leveraging the robust network of private charities and medical providers in the state, letting them create the solutions, partnerships and mentorships that lead people to better care and better health.
Otter’s latest health care proposal doesn’t do that. It simply makes a new group of Idahoans dependent on a new government entitlement program, which is not a solution at all.
However, Otter’s announcement contains a flicker of good news. His proposal very likely means Medicaid expansion is dead for the year. Otter has been notoriously noncommittal when it comes to Medicaid expansion. Having waged war in 2013 to adopt an Obamacare insurance exchange — Idaho is still the only Republican-controlled state in the country to have one — Otter has refused to say whether he’d take the next Obamacare step and expand Medicaid.
Now, instead of playing the annual will-he-or-won’t-he-propose-expanding-Medicaid game, Otter’s playing a new, but familiar, entitlement game. His idea already has the support of Rep. Fred Wood of Burley and Sen. Lee Heider of Twin Falls, the Republican chairs the the Legislature’s Health and Welfare Committees. Other legislators should be more reluctant. The question is whether Otter will twist arms as hard as his was 13 years ago to get the $30 million plan passed — and how many legislators are willing to have their legacies tarnished by a yes vote.