Which plan is best: Gov. Butch Otter’s Primary Care Access Program (PCAP), or SB 1205 Healthy Idaho, a.k.a. “Medicaid expansion”? Which plan will best assist 78,000 of our fellow citizens lacking health coverage?

Inaction is not a legitimate option. It makes no sense to leave people uncovered, and cost millions of state tax dollars in the catastrophic emergency payment fund (CAT). The Idaho CAT fund was budgeted for $36 million for 2015.

As a family physician with more than 20 years experience practicing in the Air Force, a Nampa community health center and now private practice in Meridian, I have the seen the limitations of each major healthcare payer system, spanning the gamut from socialized medicine to complete absence of formal insurance coverage. My reflective conclusion is to strongly support any proposal that allows physician medical decision-making based on patient medical needs, not payer source.

At present, I do not always have that luxury. For example, “Katie” is an adult patient of mine who only has access to primary care (me) via a low monthly subscription model (Direct Primary Care). She has a progressive tumor growing in her skull where the spinal cord exits. She knows it is slowly killing her, but without insurance she is more worried about paying her last hospital bill so she can die debt free and not burden her daughter. While I care for her diabetic, cardiac, pulmonary, psychiatric and other conditions, her temporarily treatable brain tumor continues to grow.

Would PCAP meet the goal of treating patients like Katie based on their medical needs? Sadly, the answer is no, as readily acknowledged by both supporters and opponents. Spending $30 million on PCAP will result in having $30 million less in the state checking account for other priorities and still leave gaping holes in medical coverage for patients. PCAP would provide limited outpatient clinic visits to state citizens currently ineligible for the insurance exchange subsidies, yet would fail to cover prescriptions, labs, imaging, referrals, ancillary services (e.g. physical therapy), emergency care and hospitalization.

In contrast, SB 1205 Healthy Idaho Plan provides a superior option which supports physician directed care. With money saved from:

  1. Elimination of state and county indigent funds, and
  2. $590 million in federal taxes returning to Idaho,

The Idaho Medical Association estimates our state can spend the same $30 million and have a net gain of $25 million to spend on other needs (like infrastructure). We would also provide comprehensive medical care, picking up all the gaps that PCAP misses.

While some will argue that SB 1205 Healthy Idaho may give eligible Idahoans all-inclusive care and simultaneously increase state funds, it would still spend federal tax dollars. While true for SB 1205 Healthy Idaho Plan, it is also true for PCAP since the community health centers (which will be the primary sites capable of accepting the proposed PMPM payments and sliding scales), are substantially underwritten by federal grant money. Such health centers lack patient enrollment capacity, and will have difficulty hiring significant numbers of new physicians, given their current budget limitations and inability to match market competitive salaries.

Bottom line – SB 1205 Healthy Idaho is the most fiscally sound and medically competent plan proposed in the 2016 legislative season. Despite declarations that PCAP has less financial risk for Idaho taxpayers, both PCAP and SB 1205 Healthy Idaho involve increased federal tax spending, and Idaho would be far better served by gaining a net $25 million plus complete medical coverage for our gap population. 

Brian Crownover, MD, FAAFP

Lt Col (ret), USAF, MC

Owner – Treasure Valley Family Medicine