Stuck in the Medicaid gap
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NFL PLAYOFFS Wild- ca r d w eekend: C ol ts r a ll yt o b e a t K. C.; Sa in ts u pend Ea gle s PREVIEW OF TODAY’S GAMES • IN SPORTS IDAHO MOMENTS A ne w st a rt in a ne w home fo r one B oi s ef a mil y LIFE, L1 I d a ho S t a t e s m a n JANUARY 5, 2014 29° / 14° SEE A15 CLEAR $2 BSU BASKETBALL BEATS FRESNO STATE IN MW OPENER SPORTS, S1 SUNDAY EDITION 20 14 IDAHO LEGISLATURE IDAHO STATESMAN: A McCl atchy Newspaper ,1200 N. Curtis Road, Boi se, ID • P . O. Box 40, Boi se, ID 83707 • ( 208) 377 - 6200 • © 2014 I daho Stat esman, V ol . 149, No. 164, 6sections, 48 pages INSIDE TODAY “ W e don’t kno wwher e t he danger ous pl ac es ar e, and nei t her do our s heep .” ZIR GOL, nomad in Afghani stan, home of much unexploded or dnance A7 H e a l t he x c h a nge v o t e a ‘t ipping poin t’? BY DAN POPKEY dpopkey@idahostatesman. com © 2014 Idaho Statesman In the 2012 Republican primary , Danielle Ahrens gotwhipped, winning just 30 percent of the vote against Sen. Shawn Keough. When supporters urged Ahrensto try again in 2014, she shied. “I said there’s a 40-pointspread there, ” Ahrensrecalled. “Y ou can’t argue with statistics. ” She became emboldened after Keough, of Sandpoint, voted for a state- run health insurancemarketplace in F eb- ruary and March, making I daho the onl y state with both aRepublican governor and Republican-led Legislature to do so underthe Affordable Care Act. “Aftershe voted for Obamacare, her basejust became enraged with her , ”said Ahrens, who spentthe 2013session in Boise monitoring legislation and testify- ing on behalf of folks back home. “I kept being asked, over and over , please run. Thatwasthe tipping point. ” Keough rejects the viewshe voted “for Obamacare.” Rather , like Gov . Butch Ot- ter and other Republicans, she says a state-runexchange wasthe best wayto protect state sovereignty and jobs, and to assure accountability . The longtime vice chair of the budget committee acknowledgesthatthe rocky rollout of the exchange complicates her bid for a 10th term. Expectto see a long and dramatic campaign. “Stock up on popcorn,”said Keough, who held fundraisers in November and December and added an online donation tab on her campaign website. “I have never started this earl y . ” I daho Republican Chairman Barry Pe- terson predicts that 2014 will be the most acti ve GOP primary in his 66-year life- time, with more challengers, money and earl y campaigning. Many GOP incumbents who joined Gov. Ottertof avor a state-run planexpect primary challenges from the right. Monday: I daho businesses’ 2014 wi sh li st? I ncenti ves and tax br eaks. T uesday: Gov. Otter outlines hi s budget and priori ties in hi s State of the State Addr ess on Monday , and legi sl ators and leaders r espond. At I dahoSt at esman. c om: R ead about t he go v er nor’s s peec h and budget on Monda y af t er noon, and follo w Dan P opke y’s blog. Idaho Politics app: Get com- plete cover age and otherr e- sour ces thr oughout the session fr om our app for i OS and Andr oid. Find i t atyour phone’s app stor e. COVERING THE 2014 SESSION N urs ing ca r e ca ll u nne rv e s f a milie s BY ERIC ADLER THE KANSAS CITY STAR KANSAS CITY , Mo. — F or Denise Thomas, the choice back then was as easy as itwas joyous. Theywere young together in 1978. She was a slight and easygo- ing 26-year-old Kansas woman with curl y brownhair and a white dress. He wasthe hard-working and hard-partying Missourian— a 28-year-old with abeard who was once devil-may-care enough to racemuscle cars down the streets and li ve in abuddy’s closet. They metthrough friends and became inseparable. T o them, the vowwasreal. Do you, Denise, take Randyto be your lawfull ywedded husband, tohave and to hold, from this day forward, for better , forworse, for richer , for poorer , in sickness and health, until death do you part? “W ehad the best marriage, ”she says of somuch of their35 years to- gether . Because of that, Denise Thomas, now61, views the deci- sion she knows she must soon make as one of the most wrenching in her life. Emotionall y , physicall y and fi- nanciall y , deciding whether to place Randy in long-termnursing care because of his earl y dementia is nowtearing at her and at her conflicted famil y ,just assimilar choices confront ever more Amer- icanswith aging or ill parents, spouses or even children. More than 1.5 million Americansrecei ve care in an as- sisted-li ving or nursing facility — A wife and sons in Kansas go t hr ough t he painf ulpr ocess of deciding what i s best for a man t he y bar el yr ecogni z e. JEROME A. POLLOS /special to the Idaho Statesman Amy Workman and herson, Ben, boxup belongings attheir Coeur d’ Alene home.“It’s a bad si tuation, and I’ m stuck, ” Workman said, descri bing howshe fell into the Medi caid gap in Idaho, pr ompting her deci sion to leave the state. STUCK IN THE MEDICAID GAP BY AUDREY DUTTON adutton@idahostatesman. com © 2014 Idaho Statesman Amy W orkman and her 12-year-old son spent the holidays stuffing their Coeur d’Alene home into a moving truck. They gave awaysome furniture. They gave a neighbortheir Christmas tree. A few days after Christmas, the mother of three and heryoungest son hitthe road for Oregon. They headed west in search of health insurance. W orkmanis one of the estimated 54,780 adults in I daho who fall into the so-called Medicaid gap— a health insurance no- man’s-land being created thisyear in I daho and 24 other states where lawmakers decided nottoexpand Medicaid programs. “I t’s notright,” W orkman said. “They’re ignoring that people arefalling through the cracks. ” THE GAP OPENS The 2010 Affordable Care Act ordered statesto offer Medicaid coverage starting Jan. 1 forthose between the poverty line and middle class. People making less than 1.38 timesthe federal poverty level — about $21,400 for a household like W orkman’s, us- ing thisyear’s guidelines — were to recei ve coverage. The federal governmentwould subsidize insurancepremiums for people who make up to four timesthe poverty line — a maximum of $62, 040 for a household like W orkman’s. In I daho, the Medicaid programis open to impoverished children, people with disabili- ties and a few other groups of people. Adults can qualify if they’reparents making less than$2,800 a year for a household the size of W orkman’s. The expansion would have added tens of thousands of adults to I daho Medicaid. But aU.S. Supreme Court ruling turned that plan upside down. The court said in 2012 that states have the powerto choose whether theywant aMedicaid expansion. I daho has opted out sof ar , and Gov . Butch Otter and members of the Legislaturehave T ens of t ho us a nds of I da ho ’s poo r e st will st a yu ninsur ed t hi sy e a r; one of t hem ma ke s a v e ry t o u gh c hoi c e JOE JASZEWSKI / jjaszewski@idahostatesman.com Reps. Ri ch Will s, left, and Gary Collins attend aDec. 10 fundr ai ser for Republi can incumbents in Downtown Boise. Will s, of Glenns F erry , was among the fi rst legi slators targeted wi th abill boar d bl asting hi svote for a state-run heal thex - change. See GOP , A14 See MEDICAID, A13 See CARE, A10 SECRETS OF DOWNTON A s S e a s on 4 of t he pop u l a r PBS s ho w ki c k s off, t a ke a t o ur of t he c h a r ac t e rs , c ust om s , c o stu me s a nd mo r e IN PARADE
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Tens of thousands of Idaho's poorest will stay uninsured this year; one of them makes a very tough choice to leave the state.
Transcript of Stuck in the Medicaid gap
NFL PLAYOFFS
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PREVIEW OF TODAY’S GAMES• INSPORTS
IDAHOMOMENTS
A newstart ina new home foroneBoise family
LIFE, L1
IdahoStatesmanJANUARY5,2014 29° / 14° SEEA15
CLEAR
$2
BSUBASKETBALL BEATS FRESNO STATE INMWOPENER SPORTS,S1
SUNDAYEDITION
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
[email protected]© 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 [email protected]
© 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/ [email protected], 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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