Idaho Examiner -
Idaho Rep. Tom Loertscher

Monday, September 19, 2005

House Highlights – Interim Report

By Tom Loertscher

It is not polite and in fact it is downright annoying to say, “I told you so.” That being the case I will refrain from saying it even though I really feel like it. During the last legislative session while debating the Medicaid budget I debated that there is a much needed course correction on Idaho’s Medicaid spending because, “What we are doing is unsustainable.” At every opportunity since then I continue to repeat the phrase hoping that at some point enough awareness will be raised to start others down the same road of thinking.

I have been requested to serve on a taskforce of House members to continue the work of finding Medicaid savings. The first meeting of the committee was this past week in Boise in hopes that there will be a jump start on these issues for the next session that convenes in January. Senator Cameron, co-chair of the Joint Finance and Appropriations Committee (JFAC) spoke first and detailed the growth of Medicaid in the fifteen years he has served in the Legislature. Shocking is the best word to describe the numbers presented, but of little surprise to those who have been involved over this period of time. While state revenues over that period have increased by an average of 9% per year, increases in Medicaid spending have increased an average of 12.5%. It doesn’t take a study or even an in depth analysis to see that this is a wreck looming on the near horizon. More interesting was his comment that, “This is unsustainable.” There’s that phrase again.

Senator Cameron, in his view, sees no long term remedies available to the legislature for corrective action. Further he explained that no matter what remedies he has seen recommended, even if taken together are short term fixes. One listening to his presentation would conclude that there are underlying problems that he and others are not willing to discuss, namely how we got here in the first place and the national nature of the whole Medical Care system. Maybe it is just too big of a problem to tackle or maybe it is not politically correct to say what a good friend of mine keeps saying, “There’s no right way to do the wrong thing.”

We then heard from the Department of Health and Welfare, with a report on their activities this interim with regard to trimming the Medicaid budget. The very first words from the person making the presentation were, “Medicaid in its present form is not sustainable.” There’s that phrase again. Charts and graphs were shown to indicate the growth and the problems. Of particular interest was an item detailing what is happening as Medical Insurance costs are increasing in the private sector. What we are seeing is what some of us predicted when the Children’s Health Insurance Program (CHIP) was started, in that as premiums for family coverage increase, those who qualify are looking to CHIP for their children. The number of Children on CHIP in Idaho has increased sharply over the years 2000-2003. Given our advertising of these programs that should come of no surprise.

Heath and Welfare gave a list of reform measures that they are attempting to implement. For some in the room it sounded very impressive, and I will concede that I think they are moving a little in the right direction at long last. Some of the items are a partial list of things that were recommended long ago by Governor Batt’s Medicaid Reform Taskforce. Every year in the past several years I and others have been urging the implementation of the reforms suggested long ago, and maybe I should derive comfort that someone has finally listened and that steps are now being taken. Nagging in the back in my mind however, is wondering how much better off we would have been had we taken action back then.

The Federal agencies are now in the throws of what they have dubbed MMA, or the Medicare Modernization Act. One of the reports for the day covered this topic and the attendant nightmare that is about to hit Idaho and the rest of the states come January 1, 2006. Aside from the fact that the feds do not at this late date have all of the details of this scheme finalized, Idaho will be required to write a check to Heath and Human Services each month for Idaho’s share of our dual eligibles. (Dual eligibles are those who are on Medicare who also qualify for Medicaid.) Our “share” is estimated over the next two years to be about $16 million. It is acknowledged that the accuracy of the estimate is in question especially when so few details are available from HHS. And in addition the Federal agency is demanding that the states provide all of the staff for sign-up during this modernization effort. Am I the only one getting that uneasy feeling?

Stay tuned as the clock winds down to the beginning of next year’s legislative session. We have been asked as a committee to come up with ideas to solve this dilemma. I think what I will be doing is repeating what I have been saying for some time. And yes I will keep saying the phrase that others seemed to have adopted from me, “Our current course is unsustainable.”