Winter and health care exchanges headed our way

By Rep. Jim Guthrie

I think most would agree. We have enjoyed an amazing fall this year. The weather has been almost perfect. But the calendar doesn’t lie and we understand what is just around the corner. The unique serenity that only a beautiful fall day can offer can be replaced with all the cruelty that the wrath of winter can muster in just a few hours time. The fall to winter transition is a great reminder that we can be comfortable one minute and feel very anxious the next.

To a certain extent, the recession has been the storm disrupting financial security. Until 2007 or so, we enjoyed a strong economy and most were unaware of the significant change to come. This economic snowstorm has shown no mercy with many losing homes, jobs, money, etc. Others have been less affected but remain tentative, unwilling to invest in the economy, or expand businesses. People, policies, and politicians are just a few of the more than ample targets for the blame game. But maybe of more concern with this particular squall is that no one knows for sure when or if April is coming.

As in the private sector, most entities of government have found the need to react to ongoing economic conditions. It goes without saying that decisions made in the last Idaho legislative session dealing with the above mentioned dilemma have not been critic free. Education reform and funding challenges for Medicaid were last year’s issues of passion and session 2012 looks to be a blood relative.

Although I do not serve on the education committee, I believe there will be proposed changes to the education reform bills. I’ve found the art of lawmaking to be ongoing and change is an inherent and necessary part of that process.

I serve on the health and welfare committee and the issues are considerable. You’ve probably heard about the requirement states have to develop a health exchange in order to comply with the Patient Protection and Affordable Care Act or PPACA. Idaho has applied for and will likely receive a 30.9 million dollar grant to develop the exchange. By default, if we do nothing the federal government will develop, implement, and operate one for us.

While doing a state exchange has been called and appears to be a no-brainer, it’s a bit more complicated that that. There is a pending lawsuit that will be heard by the U. S. Supreme Court (with a ruling expected in July 2012) that could render parts or all of the law unconstitutional.

It’s no secret that Idaho has resisted this onerous mandate. We were one of the first states to join the lawsuit and legislation last year sought to ignore parts of the law. I expect further efforts along those lines this session and a resistance to accept federal dollars, or for that matter, to develop an exchange at all. My belief is that this will be the session’s hot button issue and I expect some very spirited debate.

I have also attended meetings on changing Medicaid from a fee for service to a managed care model. Providers would be responsible for the health outcomes of a designated population for a predetermined price. It allows for local providers to manage patient care as they see appropriate and have more treatment flexibility. Optimists feel this will help eliminate duplication of services, result in better care, better health, and lower costs. Twenty six states currently have some form of managed care for Medicaid.

There’s a saying in Idaho. If you don’t like the weather, wait 15 minutes. Too bad a warm front can’t solve Medicaid problems. The good news; many smart people are working very hard cultivating ideas, like managed care, and how to deal with the requirements of PPACA. It’s critical we make the changes needed to insure that the insatiable appetite of health care doesn’t consume other very important parts of our budget and compromise the many other needs of our state.

It’s getting cold. I must find a coat. Even though I shiver a smile comes across my face. In my 56 years I can recall many long, hard winters, but they always end, and spring always comes.

Jim Guthrie of McCammon is a member of the Idaho House of Representatives.