This past weekend, I helped host our annual Lincoln Day Dinner fundraiser. There were politicians and candidates from the lowest office to a sitting US Senator present. Top to bottom, all were campaigning. Top to bottom, all showed revulsion at the mention of Medicaid and the problems it’s creating. All passed the buck to someone else, including the sitting US Senator.
With 105 Idaho legislators from all corners of the state and 31% of Idaho’s kids on Medicaid, it’s statistically impossible that none of these legislators are touched by it, either having been enrollees, or their kids or grandkids having been or currently being enrolled. Yet there is this disdain for doctors who accept it. They didn’t create it. They don’t particularly like it. Politicians leave them with no choice but to accept it, and leave it impossible to accept.
In the Pocatello region, there are 7000 kids on Medicaid. In Idaho Falls, 10,000 kids are on Medicaid. These are the two largest pediatric markets in Southeast Idaho. Should doctors refuse it, 17,000 kids lose medical care. Should they accept it, they’re reviled by their own representatives as government dependents.
That was the actual messaging from Representative Ben Fuhriman of Blackfoot to us in our requests for help: “The legislature has concerns about businesses that are dependent on supplemental government programs.” Where was the concern when Representative Fuhriman gave youth health funding to restore adult supplemental programs? Does this representative understand that they are the ones who set reimbursement below the cost of services delivered? Does he know that they were the ones who created a system that requires supplemental programs and asked doctors to participate to keep the budget in check? This amounts to political spousal abuse. “Why did you make me hit you?”
Last fall, when we were working to fix this issue, Representative Cheatum told my wife at a local gun show that he only had one vote and couldn’t help. This weekend, he seemed apologetic toward the plight of pediatrics and then passed the buck by blaming representatives of the Magic Valley, i.e., the Gang of 8. Does Representative Cheatum know that Representative Cayler of the G8 sat down with us for three hours and then carried the bill to fix the issue in the House Health and Welfare Committee? Does he know that G8 Representatives Hostetler and Leavitt drove from Twin Falls to attend our luncheon and texted during the session to ask about our progress? On this issue, not a single Pocatello representative or senator stepped up to represent the children of Pocatello.
Regarding our chronicled Medicaid progress, it is dead. Coeur d’Alene Pediatrics was forced to sell to a government-carved-out non-profit. Idaho Falls Pediatrics was forced to sell to a private equity firm. Pocatello Children’s is weighing their options while attempting to weather the storm. Dozens of other clinics are faced with similar crises but have no voice. The legislature even took funding for youth health initiatives from the 2007 Big Tobacco settlement and allocated it to adult behavioral health. We asked for restoration of Medicaid-wide case management at a cost of $18 per patient for 350k patients. They gave it to 200 adult behavioral health patients at a cost of $20k+ per patient. Even the Democrats are guilty here and called that a win. Allies are hard to find.
On a recent Idaho Ranch Podcast, Representative Redman of Coeur d’Alene sat down to discuss Medicaid with host Matthew Todd. At one point, Redman admits that the legislature weighed able-bodied adults vs. the vulnerable and they chose to cut the vulnerable. How bizarre, punitive, and short-sighted.
This is the choice that the public has handed to the legislature by passing Expansion by referendum. There is a finite pool of funds for the safety net, and we have to decide where those will go. We were promised $30 million in unfunded liabilities covered by Expansion. We’re nearly five times that in cost. Ultimately, hospitals, government-carved-out clinics, and associations with deep pockets have been heard. Hospitals can use presumptive eligibility to enroll uninsured adults in Medicaid in the ER, and, regardless of whether they qualify, the cost is shifted to the Feds.
I often hear the argument that the state pays a dollar and the Feds add nine as justification for Medicaid spending. It’s a Ponzi scheme, just like the Federal Reserve, which requires banks to hold one dollar to lend ten. The other nine dollars come from the printing press and create debt. The end result is that the Federal healthcare behemoth grows, and when it accounts for a third of patients and politicians slash doctors’ reimbursement below cost, it leaves the most efficient and lowest-cost providers to sell their businesses. Only those reimbursed at the highest government-carved-out rates can survive, and everyone else becomes leveraged for acquisition.
The greatest tragedy in all of this is that the medical freedom our legislature hopes to achieve comes through independent doctors. The kind of doctors who don’t dance in the streets for Black Lives Matter while you’re locked in your home during a pandemic. The kind to support crisis pregnancy centers. The kind to reject experimental gender care, and the kind to correct the Republican Party platform when it criminalizes a menstrual cycle.
Two years ago, my wife and I served as delegates to the Idaho GOP Summer Convention and saved them from setting the bar for life at fertilization, which would have categorized every failed pregnancy as an abortion. They owe her a debt of gratitude. She was repaid eight months later when the legislature effectively put the entire category of pediatrics on the ropes by selling Medicaid to an out-of-state insurance corporation and slashing reimbursement for private practice below cost.
In the coming November election, it is likely that abortion will be presented on the ballot, and we will fight with everything that we have to defeat it, just like we did with Proposition 1. We are a dying nation and need people to have families and to support those families for the furtherance of this nation. We are big supporters of the Compassion & Hope Pregnancy Center in Pocatello. My wife likes to tell the story of how she was saving a 24-week newborn in residency while down the hall, a child of the same gestational age was being terminated. Doctors are trained to heal, not destroy.
Being pro-life doesn’t end when a child is born. We believe in personal responsibility, and we do recognize that the more the government gets involved, the worse things typically get. Still, we believe that the safety net exists for those who cannot do for themselves, and not for corporate welfare. It would behoove the Idaho legislature to adopt the same philosophy.
Photo by Aparna Johri on Unsplash
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