Knowing that Medicaid expansion is not an option, Department of Health and Welfare Director Dick Armstrong hopes to get traction for an alternative. That alternative would provide health coverage to an estimated 78,000 Idahoans who presently don’t have insurance and don’t qualify for Medicaid or Obamacare tax credits.

Legislative Democrats have already signaled that they won’t buy in. They’re fixated on advancing Obamacare via Medicaid expansion. That means conservatives in the Legislature hold the key to passage of Armstrong’s alternative. Ultimately, conservatives want to embrace a patient-focused, free market approach to health care. We can have one, and it would work as follows.

A patient who needs health care coverage would approach a local community organization for help. That organization raises the money to provide health coverage via an assortment of programs tailored to meet that patient’s needs. That might include membership in a Direct Primary Care, funds for visits to a community care clinic, money for prescription drugs, and the like. The money raised would be matched, at some level, by state funds. It would be the organization’s responsibility to decide what service is offered and how.

Conservatives should like this approach. It contains free market elements that connect patients to services and organizations in a community. It keeps government involvement at a minimum.

Conservatives would support legislation to do this if it commits to these design elements:

• The patient-centered program is funded with existing revenue. No new taxes are created, existing taxes are not raised. Earlier this year, Legislators told me Armstrong was pitching a proposal with a tax increase on cigarettes, including vaping products. A tax increase isn’t necessary, and frankly no conservative lawmaker would support a tax increase of any kind. After the hardship inflicted on Idahoans through tax increases in the 2015 legislative session, moderates should also view a tax increase as a deal breaker.

• The proposal puts an end to Idaho’s experiment with single-payer health care, i.e., the county indigent program and its companion state catastrophic health care fund. That program has been a costly failure that has crippled county finances and has done little to improve long-term health-care outcomes for patients. If the patient-centered legislation starts a new program, it should put the existing failed program out of its misery.  

• The patient-centered program must get politicians and bureaucrats out of the health care decision-making vortex, which is central to Idaho’s existing health care program and Medicaid. Patients and doctors need to be at the center, making the decisions about what treatment and services are used. County commissioners and Department of Health and Welfare officials have no part to play.

• Local charities are the key. They should be the ones to invest their time and their money in the health care of the people in the program. Local charities would be responsible for raising the funds, which would be be matched by the state’s contribution, and keeping the program accountable for results. If the organization is successful, the money will follow. If not, money will flow to other organizations that do a better job and have better outcomes.   

A patient-centered, community-driven health care plan would help serve as a foundation to lift people from poverty, so they don’t need ongoing government assistance. Most importantly, such a program would not depend on federal government funding, nor would federal or state public servants be involved in the decisions that are best left to patients and their health care providers.