Idaho's Legislature Failed 78,000 Idahoans
Again in its 2016 session, the Idaho Legislature, after three years of trying, failed to enact legislation that would have initiated steps to provide health care coverage for about 78,000 Idahoans whose income does not qualify them for health insurance. Options were presented, including two degrees of coverage that would have used federal funds under the Affordable Care Act, and a partial program that would have provided some state-funded aid for health care facilities, although the source of funding was not clear.
Health Care Access
Idaho has a Health Quality Planning Commission, which works with insurers, health care providers and professionals, and the Legislature on policies and programs to improve access to quality care throughout the state. In such a big state, uniform availability of health care remains a major challenge that has not been helped much by political posturing, despite three years of effort and broad public support.
On one hand, Idaho’s role in providing a state health insurance exchange helped nearly 80,000 previously uninsured and underinsured Idahoans get private health insurance. More than 90 percent of those who applied qualified for some kind of premium subsidy. But nearly as many Idaho residents don’t make enough money to qualify for the exchange, or, because of Idaho’s unrealistic qualification standard, make too much to qualify for Medicaid help. The Affordable Care Act includes a provision to cover all the cost of health care coverage for the first three years and at least 90 percent thereafter. But Gov. Butch Otter and key legislators have refused to act on accepting the Medicaid redesign recommendations presented by own Otter’s select committee on the issue.
A sore point among opponents has been the association of the word “Medicaid,” which has been interpreted as synonymous with “big government.” This is similar to the opposition initially encountered by the Affordable Care Act, which provides for both the broad availability of health insurance and the ability to provide health care services for people who can’t afford health insurance premiums but who make more than the designated income to otherwise qualify for Medicaid. Getting around that obstacle involves customizing a program for Idaho that will qualify for the provisions in the ACA, but by a name other than “Medicaid expansion,” hence the use of the term “Healthy Idaho.
Meanwhile, the politically motivated inaction is, in effect, costing Idaho taxpayers about $90 million a year in subsidies for such things as extra funding for the state’s Catastrophic Health Care program and care for veterans and prison inmates. Having Medicaid expansion could result in at least a 3 percent drop in the state’s death rate – literally saving at least 450 lives a year, or about three times the number anticipated by many Medicaid expansion advocates.
In July 2015, the National Health Council released a progress report that evaluated every state in terms of how patient-centered its health insurance market is. Idaho was one of 14 states that scored the lowest on the report, and it’s the only one of those 14 states that has its own state-run health insurance exchange.
Idaho ranked poorly in the clarity of its plan information and ability to compare plans, and in how easy it is for exchange enrollees to switch from one plan to another – something that would be much easier with the Healthy Idaho version of Medicaid redesign. Idaho scored only average on state oversight of plans being offered, transparency, and non-discrimination provisions.
Access to Care
The issue of health care is really two issues in one. First, as outlined above, is the affordability factor. The second is that of making sure people everywhere have access to health care, and in Idaho, a very big state with not so many people, hospitals and clinics are generally concentrated in urban areas. Outside of major population centers, Idaho has a dangerous lack of access to health care professionals. Idaho is one of only four states -- with Alaska, Montana, and Wyoming—that don’t have their own medical school, although up to 18 students a year from Idaho can attend subsidized medical degree programs at the University of Washington on what amounts to a stand-by basis.
The state ranks last among the 50 states and District of Columbia in the number of primary care physicians practicing here, (including general practice, family practice, OB-GYN, pediatrics, and internal medicine) at 80 per 100,000 people, compared to a national rate of 167.3 per 100,000 (and ranks 49th in the number of physicians in patient care). It’s even worse for psychiatry professionals, of which Idaho has just five per 100,000 people – the lowest ratio in the nation.
The population density factor, with so few medical facilities outside major urban areas, also means fewer emergency care facilities. Idaho ranks among the bottom 10 states for its patient safety and care environment quality due to a lack of funding and relatively few policies and procedures to improve the availability and quality of emergency medical care. The state has no emergency medical services medical director and does not require records reporting on medication and medical equipment issues that could affect emergency care.
The state has no uniform triage protocols or first-level instruction information for remote administration of life-saving care while awaiting EMS arrival. Only half of Idaho’s hospitals maintain records on race, ethnicity, and primary language, and only 27 percent have or plan for a diversity strategy for emergency care. Idaho scores among the lowest of all states in not only primary care physicians but also the number of inpatient beds available (243.3 per 100,000 people) and psychiatric care beds (13.8 per 100,000 people) available to handle a major emergency situation, and Idaho has little or no state-level disaster planning.
Among other consequences of Idaho’s poor standing in the availability of health care practitioners and facilities, the state still has the lowest rate of breast cancer screenings of all the states for women over age 40, nearly 12 percent fewer than the national median, meaning more than 122,000 of Idaho’s eligible women have not had a mammogram in the past two years. The proportion of eligible women receiving pap screenings for cervical cancer was even lower.
The National Alliance on Mental Illness (NAMI) says nearly a quarter of Idahoans are living with a mental illness. Nearly 6 percent of those people are living with a serious mental illness such as bipolar disorder. In addition, Idaho has the seventh- highest suicide rate in the country, 48 percent higher than the national average.
In 2014, 320 Idahoans killed themselves. In the previous four years, 78 percent of the suicides were men. In 2014, 60 percent of Idaho suicides involved a firearm. Between 2010 and 2014, 96 Idaho children aged 18 and under died by suicide, and 20 of those were aged 14 or younger. Suicide is second only to accidental death as the cause of death for Idahoans between the ages of 15 and 34.
Idaho is near the bottom among all states in compliance with childhood vaccination requirements. In the 2013-2014 school year, 88.2 percent of Idaho’s 23,934 kindergartners had current vaccinations for measles, mumps and rubella — one of the immunizations required by the state. This 88.2 percent rate ranked Idaho fifth-lowest in the nation. This is below the Centers for Disease Control’s standard 90 percent threshold widely believed necessary to curb the spread of contagious diseases.
Meanwhile, 1,540 Idaho kindergartners were given immunization waivers — 89 for medical issues; 147 on religious grounds; and 1,304 over philosophical concerns, and the rate continues to decline. (Added contributing factors include the state’s generous allowance for “voluntary” vaccinations, and lack of education programs about the importance of immunization against preventable diseases, underscored by the rise of a counterculture “antivaxer” movement.
For more information on childhood vaccinations, click here.
Women’s Reproductive Health
With wider availability of counseling and birth-control resources, abortion rates in America have steadily declined. Ironically, efforts to politicize, demonize, and restrict abortion availability among reproductive choices have continued to increase.
Despite recent court rulings that overturned some of the state’s most onerous restrictions, the Gem State continues to have some of the nation’s most restrictive abortion laws. Among them, in effect as of July 1, 2015, are these:
• A woman must receive state-directed counseling that includes information designed to discourage her from having an abortion and then wait 24 hours before the procedure is provided.
• Abortion is covered in private insurance policies only in cases of life endangerment, unless an optional rider is purchased at an additional cost.
• Health insurance plans from the state’s health exchange under the Affordable Care Act can only cover abortion in cases when the woman's life is endangered, rape or incest.
• Abortion is covered in insurance policies for public employees only in cases of life endangerment, unless an optional rider is purchased at an additional cost.
• The use of telemedicine for the performance of medication abortion is prohibited.
• The parent of a minor must consent before an abortion is provided. • Public funding is available for abortion only in cases of life endangerment, rape or incest.
Idaho had four abortion providers in 2011, of which two were clinics. In other words, 95 percent of Idaho counties had no abortion clinic. Sixty-nine percent of Idaho women lived in those counties.