Health care leaders tackle Proposition 2

By BRIAN WALKER

Staff Writer

COEUR d'ALENE — If Medicaid expansion is going to make its breakthrough in Idaho, the conversation has to focus on changing the health care system to drive down costs, a panel of local health care professionals agreed.

Mike Baker, Heritage Health CEO; Patt Richesin, Kootenai Care Network president; and Rick Rasmussen, Northwest Specialty Hospital CEO, discussed during Tuesday's Legislative Forum presented by the Coeur d'Alene and Post Falls chambers of commerce the Medicaid expansion proposal that will be on the Nov. 6 ballot as Proposition 2.

Richesin told about 50 people at the forum at the Best Western Plus Coeur d'Alene Inn that dialogue on the proposal shouldn't be on perceived "losers" if expansion passes, but on addressing the needs of the working poor and strengthening the economy.

"If we have a conversation about who wins and who loses, we all lose," she said. "I believe we have to look at how we create a model in Idaho that really addresses the needs of the residents.

"There will be people who argue that this doesn't benefit me, but if we start there that's a huge mistake. I see it as an investment in the economy."

Expansion opponents argue the current Medicaid program is already taking away funds from other needs such as schools and roads by growing at a faster rate than other major programs. Some equate the proposal to an expansion of the Affordable Care Act (Obamacare) and welfare. They believe it increases Idaho's reliance on the federal government, as much of the cost would be covered through federal funds.

But Baker said the Medicaid expansion debate shouldn't be centered on a win-lose basis.

"Bring this back to the middle and figure it out," he said. "We've got to have compromise. There are people who are going to try to beat the system, but you'll find most people wake up to try to live the best life they can. We have to redesign the system because we can't focus on the patients in front of us."

Rasmussen said he believes people with non-emergencies should be seen at family practices or urgent cares, not emergency rooms, where costs are much higher and drive up taxpayer expenses. He also believes health care needs to be transparent on prices as they can vary widely between facilities.

"I want to support the people who are working hard, but without a cap on pricing we're adding (to the problem)," he said. "(Ceiling pricing) could make this a winner for everybody."

The panelists said there are local initiatives aimed at driving health-care costs down such as using "mid-level" positions, training nurses in chronic care management, and exercise and nutrition programs that prevent health problems from rising.

"We need to keep the eye on clinical outcomes while bending the cost curve," Richesin said.

Rasmussen said quality of care also shouldn't suffer as a result of health care reform.

"The quality piece still has to be there because it's about the patient," he said.

While Medicaid expansion has failed to pass the GOP-dominated Legislature, supporters in July submitted more than the minimum number (56,192) of signatures necessary for the proposal to be placed on the ballot.

Supporters say expanding Medicaid eligibility is the simplest way to help those in the "Medicaid gap" — an estimated 50,000 to 60,000 of the working poor who don't qualify for Medicaid now but also can't get subsidies on Idaho's health insurance exchange.

Sen. Mary Souza, R-Coeur d'Alene, said legislators should respect the will of the voters on Medicaid expansion, but other forum attendees predicted that won’t be the case.

"If either of the propositions pass, I have no doubt the Legislature is going to take some sort of run at them," said Rep. Paul Amador, R-Coeur d'Alene. "When you have 70 cats (legislators) there's too many ideas floating around to not make an attempt at those."

John Watts, Idaho Chamber Alliance lobbyist and a veteran on legislative matters, agrees.

"Everybody keeps saying to let the will of the people stand, but I'll believe it when I see it," he said. "I can't see the Legislature just saying, 'OK, let's just expand Medicaid outright.'"

The other proposition on the ballot, Proposition 1, would legalize video terminals for betting on historical horse racing in Idaho.

Foes call the proposal "slot machine expansion," while supporters say the machines are needed for live horse racing to survive in Idaho and would create jobs and inject money into the economy.

The Coeur d'Alene Chamber of Commerce board unanimously voted to oppose Prop 1, citing faith in the legislative process that led to the current ban on the use of such gaming machines.