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LIFE, L1

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2014 IDAHO LEGISLATURE

IDAHOSTATESMAN:AMcClatchyNewspaper, 1200N.CurtisRoad,Boise, ID•P.O.Box40,Boise, ID83707• (208)377-6200•©2014 IdahoStatesman,Vol. 149,No. 164,6sections, 48pages

INSIDETODAY “Wedon’tknowwhere thedangerousplacesare,andneitherdooursheep.” ZIRGOL, nomad inAfghanistan, homeofmuchunexplodedordnanceA7

Healthexchangevotea ‘tippingpoint’?BYDANPOPKEY

dpopkey@idahostatesman.com© 2014 Idaho Statesman

In the 2012 Republican primary,Danielle Ahrens got whipped, winningjust 30 percent of the vote against Sen.ShawnKeough.When supporters urgedAhrens to try again in 2014, she shied.

“I said there’sa40-point spread there,”Ahrens recalled. “You can’t argue withstatistics.”

She became emboldened afterKeough, of Sandpoint, voted for a state-runhealth insurancemarketplace inFeb-ruary andMarch, making Idaho the onlystate with both a Republican governorand Republican-led Legislature to do sounder theAffordableCareAct.

“After she voted for Obamacare, herbase just became enragedwith her,” saidAhrens, who spent the 2013 session inBoisemonitoring legislation and testify-ing onbehalf of folksback home.

“I kept being asked, over and over,

please run.Thatwas the tipping point.”Keough rejects theviewshevoted “for

Obamacare.”Rather, likeGov. ButchOt-ter and other Republicans, she says astate-run exchange was the best way toprotect state sovereignty and jobs, and toassure accountability.

The longtime vice chair of the budgetcommittee acknowledges that the rockyrollout of the exchange complicates herbid for a 10th term. Expect to see a longanddramatic campaign.

“Stock up on popcorn,” said Keough,who held fundraisers in November andDecember and added anonlinedonationtab on her campaign website. “I havenever started this early.”

IdahoRepublicanChairmanBarryPe-tersonpredicts that 2014willbe themostactive GOP primary in his 66-year life-time,withmore challengers, money andearly campaigning.

ManyGOP incumbents who joinedGov.Otter to favora state-run plan expect primary challenges from the right.

Monday: Idahobusinesses’2014wish list? Incentivesandtaxbreaks.

Tuesday:Gov.Otteroutlineshisbudgetandpriorities inhisStateof theStateAddressonMonday,and legislatorsandleaders respond.

At IdahoStatesman.com:Readaboutthegovernor’sspeechandbudgetonMondayafternoon,andfollowDanPopkey’sblog.

IdahoPoliticsapp:Getcom-pletecoverageandother re-

sourcesthroughoutthesessionfromourappfor iOSandAndroid.Finditat yourphone’sappstore.

COVERINGTHE2014SESSION

Nursingcare callunnervesfamilies

BYERICADLERTHE KANSAS CITY STAR

KANSAS CITY, Mo. — ForDenise Thomas, the choice backthenwas as easy as itwas joyous.

They were young together in1978. Shewas a slight and easygo-ing 26-year-old Kansas womanwith curly brown hair and awhitedress. He was the hard-workingand hard-partyingMissourian— a28-year-oldwith a beardwhowasonce devil-may-care enough torace muscle cars down the streetsand live in a buddy’s closet.

They met through friends andbecame inseparable.

To them, the vowwas real.Do you, Denise, take Randy to

be your lawfullywedded husband,to have and to hold, from this dayforward, for better, for worse, forricher, for poorer, in sickness andhealth,until deathdo youpart?

“We had the bestmarriage,” shesaysof somuchof their 35years to-gether.

Because of that, DeniseThomas, now 61, views the deci-sion she knows she must soonmake as one of the mostwrenching in her life.

Emotionally, physically and fi-nancially, deciding whether toplace Randy in long-term nursingcare because of his early dementiais now tearing at her and at herconflicted family, just as similarchoices confront evermoreAmer-icans with aging or ill parents,spousesor even children.

More than 1.5 millionAmericans receive care in an as-sisted-living or nursing facility —

Awife and sons inKansas gothrough thepainful processof decidingwhat isbest for aman theybarely recognize.

JEROMEA.POLLOS/ special to the Idaho StatesmanAmyWorkmanandher son,Ben,boxupbelongingsat theirCoeurd’Alenehome. “It’sabad situation,and I’m stuck,”Workman said, describinghowshe fell into theMedicaid gap in Idaho,promptingherdecision to leave the state.

STUCK INTHEMEDICAIDGAP

BYAUDREY DUTTONadutton@idahostatesman.com

© 2014 Idaho StatesmanAmy Workman and her 12-year-old son

spent the holidays stuffing their Coeurd’Alene home into a moving truck. Theygave away some furniture. They gave aneighbor theirChristmas tree.

A few days afterChristmas, themother ofthree and her youngest son hit the road forOregon. They headed west in search ofhealth insurance.

Workman is one of the estimated 54,780adults in Idaho who fall into the so-calledMedicaid gap — a health insurance no-man’s-land being created this year in Idahoand 24 other states where lawmakers

decided not to expandMedicaid programs.“It’s not right,”Workman said. “They’re

ignoring that people are falling through thecracks.”

THE GAP OPENSThe 2010 Affordable Care Act ordered

states to offer Medicaid coverage startingJan. 1 for those between the poverty line andmiddle class. People making less than 1.38times the federal poverty level — about$21,400 for a household likeWorkman’s, us-ing this year’s guidelines—were to receivecoverage. The federal government wouldsubsidize insurance premiums for peoplewho make up to four times the poverty line— a maximum of $62,040 for a household

likeWorkman’s.In Idaho, theMedicaid programis open to

impoverished children, peoplewith disabili-ties and a few other groups of people.Adultscan qualify if they’re parents making lessthan $2,800 a year for ahousehold the size ofWorkman’s. The expansion would haveadded tens of thousands of adults to IdahoMedicaid.

But a U.S. Supreme Court ruling turnedthatplanupsidedown.Thecourt said in2012that stateshave thepower tochoosewhethertheywant aMedicaid expansion.

Idaho has opted out so far, andGov.ButchOtter and members of the Legislature have

Tens of thousands of Idaho’s poorest will stay uninsuredthis year; one of themmakes a very tough choice

JOEJASZEWSKI/ jjaszewski@idahostatesman.comReps.RichWills, left,andGaryCollinsattendaDec. 10fundraiser forRepublican incumbents inDowntownBoise.Wills, ofGlennsFerry,wasamong the first legislators targetedwithabillboardblastinghisvote fora state-runhealthex-change.SeeGOP,A14

SeeMEDICAID,A13SeeCARE,A10

SECRETSOFDOWNTONAsSeason4of thepopular

PBSshowkicksoff, takea tourof thecharacters,customs,costumesandmore IN PARADE

made comments to suggestthat theydon’t foreseeanex-pansion bill passing thisyear.

That means Workmanand parents like her, whomake between $2,800 and$15,510 a year, fall into theMedicaid gap. (For single,childless adults, the thresh-old is lower.)

Those people basicallyhave threeoptions:Gowith-out insurance, pay full pricefor a plan, ormove to a statethatopted in.

THE PROS,THE CONSThere are two sides to the

Medicaid expansion debate— and an election this yearisexpected tomake lawmak-ers reluctant to take up avote on a bill.

Giving Medicaid to low-income adults would makealmost irrelevant a cata-strophic-medical programthat costs Idaho taxpayerstens of millions of dollars ayear; the savingsareestimat-ed to be as high as $1 billionover thenext 10 years.

It would spare some em-ployers theexpenseof insur-ing their lowest-wage em-ployees or paying fines fornot covering them. And itwould mean Idaho reaps abenefit from the money itstaxpayers will contributethis year to support Medi-caid expansionsnationally.

But opponents and skep-tics of Medicaid expansionoffer theirown arguments:

ÆWhat if the federal gov-ernmentdoesn’tkeep itsendof the bargain — paying90 percent to 100 percent ofthe costs for new enrollees— and leaves it up to statesto pay for a wave of newMedicaid patients?

Æ Idaho’s Medicaid pro-gram already costs about$2 billion a year, and the billis rising.One-quarter of thatmoney comes from stategeneral funds. Most of therest comes from federal cof-fers.

Æ Idaho could revamp itsMedicaid program beforeadding people to it.Otterlikes thisoption,and the Ida-ho Association of Com-merce and Industry askedhim to consider how to re-form the program to pay forhigh-quality, high-valuemedical care instead of pay-ing by the hour or by thevial, as itdoesnow.

Æ They don’t like the Af-fordableCareAct in generaland don’t want Idaho takingpart in it.

GETTING COVEREDWorkman’s last job, as a

home-careaide fora special-needs child, did not offerhealth insurance.

But after injuring herselfatwork ayear ago, sheneed-edphysical therapy, she said.She was denied workers’compensation benefits tocover prolonged therapy —a decision she is appealing— and started paying out ofpocket to see doctors. Sheestimates she has racked up$8,000 inmedicalbills in thepast six months. She haspaid $500 of them.

“Iwent to apply for Oba-macare,” she said. She triedsigning up for a plan fromYour Health Idaho, thestate’s exchange.After threefailed attempts at enrollingthrough the website, Work-manwent to an agent.

The income screeningprocess didn’t count childsupport or a workers’ com-pensation check, “so I basi-cally had zero income,” shesaid. That meant she quali-fied for Idaho’s zero-incomeMedicaid program.

At least, that’s how itseemed— until she tried tosign up for Medicaid andlearned that child supportmoney and workers’ comppushed her over the line foreligibility.

“Ihaveprobablyabout$12in my (bank) account,”Workman said before leav-ing forOregon. “I have to dosomethingproactive formy-self, or I’m not going to beable to put a roof over myson’s head. ... Iwant to bebetter somy son can lookuptome if I’mworking.”

During her first week inOregon, Workman scopedout some apartments.

But before that, she ap-plied for its Medicaid pro-gram, and hoped to hearsome good news once herapplicationwasprocessed.

AudreyDutton: 377-6448,Twitter:@IDS_Audrey

IDAHOSTATESMAN• IDAHOSTATESMAN.COM SUNDAY, JANUARY5,2014 • A13FROMTHEFRONTPAGE

MEDICAIDCONTINUED FROMA1

Audrey hascoveredIdahoMed-icaidandtheAfford-ableCareAct for theStatesmansince January2011.

AUDREYDUTTONAmyWorkmanandher sonBen takeabreak frompackingin theirapartment inlateDecember.Workmanarrivedata friend’shouse inOregononaSundayand spentMondaymorningapplyingfor that state’sMed-icaidprogram.Benwasgrantedcover-age immediately,butAmywas toldherapplicationwould take time toprocess.

JEROMEA.POLLOS/special to the IdahoStatesman

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