<html><head><meta http-equiv="content-type" content="text/html; charset=utf-8"></head><body dir="auto"><div><span></span></div><div><meta http-equiv="content-type" content="text/html; charset=utf-8"><div style="-webkit-text-size-adjust: auto;">And the lame get lamer . . .</div><div style="-webkit-text-size-adjust: auto;"><br></div><div style="-webkit-text-size-adjust: auto;">Courtesy of today's (January 4, 2014) Spokesman-Review.</div><div style="-webkit-text-size-adjust: auto;"><br></div><div style="-webkit-text-size-adjust: auto;">----------------------------------</div><div><h1 style="font-size: 28px; margin: 0px 0px 10px; clear: both; line-height: 1.2; color: rgb(17, 17, 17); font-family: Arial, sans-serif; -webkit-text-size-adjust: 100%; background-color: rgb(255, 255, 255);">Idaho GOP plays down 2014 Medicaid expansion</h1></div><div><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">BOISE – Republicans on Friday dampened expectations about broadening Medicaid health care eligibility this year for poor Idaho residents on the same grounds they balked in 2013: Before taking extra federal money, the existing system should be overhauled to encourage beneficiaries to take personal responsibility for their health.</span></div><div><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><br></span></div><div><span style="background-color: rgba(255, 255, 255, 0);">President Barack Obama’s health care overhaul envisioned adding many low-income singles, among others, to the program, but the U.S. Supreme Court left the final decision up to states.</span></div><div><span style="background-color: rgba(255, 255, 255, 0);"><br></span></div><div><span style="background-color: rgba(255, 255, 255, 0);">Gov. Butch Otter told reporters at the Capitol in Boise during the Associated Press’ legislative preview that expanding Medicaid without revamping the government-backed health care system for low-income, elderly and disabled people wasn’t acceptable. He proposes a system in which payments go to health care providers based on treatment outcomes, not just services provided, as well as boosting co-pays to penalize people who don’t follow doctors’ orders, including losing weight when instructed to do so.</span></div><div><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">“It doesn’t do any good if you’re just paying for every time a patient crosses that threshold,” Otter said. “I want to see better outcomes.”</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">While likely relegating Medicaid expansion to beyond 2014, Otter indicated he favors investigating what Arkansas has done with additional federal money to help poor people buy private insurance. He hinted he may address the topic Monday during his State of the State speech, to kick off the coming session.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">Tom Shanahan, a spokesman for state Department of Health and Welfare Director Dick Armstrong, said Idaho worked last year to get “verbal approval” from the U.S. Department of Health and Human Services to deviate from existing Medicaid programs for newly covered residents, to help meet Otter’s goals.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">But the state would have to agree to expand Medicaid before seeking a formal waiver, Shanahan said. That’s unlikely to happen soon, he said, since expansion discussions have largely ended.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">“Unless the state says it’s going to do it, we really can’t apply,” Shanahan said Friday.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">By eschewing expansion along with 25 largely Republican-led states, some 54,780 Idaho residents will fall into this gap: They’ll be eligible neither for Medicaid coverage nor tax subsidies to help them pay for insurance plans sold via the Your Health Idaho exchange, another key provision of Obama’s 2010 health care law.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">Democrats, including House Minority Leader John Rusche of Lewiston, are pushing expanding Medicaid to cover people up to 138 percent of the federal poverty line, on grounds it will save Idaho counties hundreds of millions over the next decade that they would otherwise spend on Idaho’s existing county- and state-financed Catastrophic Health Care program that covers medical bills for indigent people. That program could be eliminated, with the federal government covering the cost of Medicaid expansion that would replace it.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">At Friday’s event, Rusche labeled the GOP’s refusal to expand Medicaid as “fiscally irresponsible” – and a sign the issue has fallen victim to May 2014 primary election politics: Republicans still smarting from a bruising 15 hours of debate last session over a state-based health insurance exchange don’t relish repeating such a divisive exercise over Medicaid expansion, especially just before facing conservative voters for whom Obama’s law is unpopular.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">“I said at the end of the last session that if we didn’t deal with it last year, we wouldn’t deal with it this year, because it’s an election year,” said Rusche, a former pediatrician and health insurance executive. “And I still stand by that statement.”</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">Senate President Pro Tem Brent Hill, R-Rexburg, countered that merely considering the savings Rusche expects Idaho to reap from Medicaid expansion ignores broader costs to a federal government already running big budget deficits.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">“I’m an accountant, I like numbers,” Hill said. “We’re sitting on top of a $16 or $17 trillion-dollar debt right now that some of us think is a problem.”</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">House Speaker Scott Bedke, R-Oakley, suggested that even if he wanted to expand Medicaid, he didn’t have the votes in his GOP caucus.</span></p><p style="margin-bottom: 21px; overflow: visible !important;"><span style="background-color: rgba(255, 255, 255, 0);">“I temper my response with what I think we can do as a Legislature – or what I have votes to move,” he said.</span></p></div><div style="-webkit-text-size-adjust: auto;">-----------------------------------<br><br><div><span style="background-color: rgba(255, 255, 255, 0);">Seeya 'round town, Moscow, because . . .</span></div><div><span style="background-color: rgba(255, 255, 255, 0);"><br></span></div><div><span style="background-color: rgba(255, 255, 255, 0);">"Moscow Cares" (the most fun you can have with your pants on)</span></div><div><a href="http://www.moscowcares.com/" style="background-color: rgba(255, 255, 255, 0);"><font color="#000000">http://www.MoscowCares.com</font></a></div><div><span style="background-color: rgba(255, 255, 255, 0);"> </span></div><div><div><span style="background-color: rgba(255, 255, 255, 0);">Tom Hansen</span></div><div><span style="background-color: rgba(255, 255, 255, 0);">Moscow, Idaho</span></div></div><div><span style="background-color: rgba(255, 255, 255, 0);"><br></span></div><div><span style="background-color: rgba(255, 255, 255, 0);">"There's room at the top they are telling you still.</span></div><div><span style="background-color: rgba(255, 255, 255, 0);">But first you must learn to smile as you kill,</span></div><div><span style="background-color: rgba(255, 255, 255, 0);">If you want to be like the folks on the hill."</span></div><div><span style="background-color: rgba(255, 255, 255, 0);"><br></span></div><div><span style="background-color: rgba(255, 255, 255, 0);">- John Lennon</span></div><div><span style="background-color: rgba(255, 255, 255, 0);"> </span></div></div></div></body></html>