By Dr. John M. Livingston | Medical Policy Adviser

As we begin 2019 and a new legislative session, I see an opportunity to begin healthcare reformation in Idaho. Regardless of how the state Supreme Court may rule on Medicaid expansion, we conservatives must continue to be proactive and provide a positive path forward when we try to take care of those on the margin, decrease the cost of coverage, and improve access and outcomes for everyday citizens.

Here are my suggestions for Idaho legislators:

Move forward on non-Obamacare-compliant insurance policies. Last year, then-Gov. Butch Otter and his lieutenant governor, Brad Little, proposed that the state allow the sale of insurance plans that do not comply with Obamacare's burdensome and pricy mandates. To its credit, the Trump administration has moved ahead with change in insurance regulations allowing the sale of renewable short duration insurance plans, thus allowing individuals to choose coverage more tailored to their needs and at less cost, essentially getting to the goal that Otter and Little sought.

Little, sworn in as Idaho’s governor on Friday, and the Legislature should codify these changes, which would allow consumers to access coverage that is less expensive than Obamacare-heavy plans.

The Trump administration also moved forward with new regulations to make Association Health Plans more readily available. These plans allow small businesses and trade associations to come together in the purchase of health insurance at for less money.

Fight for healthcare transparency where public monies are used. At present, hospitals receive millions of dollars in exemptions to sales and property taxes and billions of dollars in revenue from government healthcare programs. Yet these hospitals are unwilling to be transparent about how much a patient can expect to spend for a visit. I am a retired surgeon and my son is a partner at a Big Four accounting firm. Together, even we cannot figure out our medical bills. This alone demonstrates how the large providers and carriers are purposefully trying to game the system.

Hospitals that provide quality access to care at a low cost, where that cost is easily decipherable and can be learned in advance should get tax breaks, which is not true of the present system. Furthermore, the Legislature should require hospitals that receive more than $100 million of government transfer payments undergo and make public an independent annual signed partners audit—not just the annual tax form.

People deserve to know how money is being spent by institutions that receive so much taxpayer cash.  

The Legislature should also use tax exemptions and government transfer payments as a tool to return to pre-2000 rules allowing patients to see doctors of their own choosing even if out of network.  A recent Wall Street Journal article tells how large hospital systems that control referrals to labs, x-ray and imaging, rehab and specialty referrals will pay 100-500 percent more for the same service than an out of network referral and why insurance carriers pay for these overcharges? Hospitals that exclude insurance providers or bar qualified practitioners for no reason should not benefit from the largess of taxpayers.

Conduct a Medicaid audit. Examine how the state contracts for health care services for those on Medicaid. A system where insurance carriers pre-budget for future costs of care (in the military, we called this "Op-Tar "for operational targets) has cost taxpayers billions, and Idaho is no exception.

Additionally, pharmacy benefits managers, most of which are run by insurance companies, are exploiting taxpayers for billions. Finally, the Legislature should see to an audit of the Medicaid rolls to make sure people receiving the benefits are entitled to those benefits, and legislative auditors should conduct a comprehensive review of Department of Health and Welfare transactions and contracts to identify weaknesses in oversight.

Bring in outside experts. I recommend that the Legislature appoint a panel of knowledgeable citizens with an understanding of medicine, insurance, and economics to look at the intricacies of the departments of health and welfare and insurance and to make recommendations that will move us forward toward health care reform. No politicians allowed. No bureaucrats allowed. No special interests allowed.

The problem over the past 65 years is not that the private sector has failed, but rather  that the free market has not been allowed to function.

When special interests and government regulators exert inappropriate leverage in the marketplace, the market no longer functions. And when it doesn't function, the usual suspects align to create new "solutions" that all involve growing government and giving more control to the special interests.

Let's hear from some new voices, people from the private sector, who really understand what's going wrong.

Build on last year's decision to remove the barriers to the sale and purchase of insurance across state lines. Idaho has restricted health insurance sales for nearly half a century. Last legislative session, lawmakers passed a bill to repeal the ban on the sale of insurance across state lines. Allowing people to also purchase insurance from U.S. territories, which are exempted from Obamacare's mandates, would also provide consumers more choices at less cost.

Expand the state's charity care statutes to extend malpractice immunity to doctors who provide services to low-income patients in their offices. Right now, state law limits that immunity to doctors providing care at a charity clinic. Expanding the immunity might encourage doctors to see more patients with limited means.

These are just examples of the policy reforms that the Legislature could examine right now, this year. There's no reason to delay. I look forward to working with legislators that have an interest in these policy reforms.