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John Livingston

Does Anybody Care?

There are several things our State Legislature and Governor could do to help all Idahoans this next legislative session. They could make food cheaper by repealing the grocery tax. They could make owning a business and owning a home or property easier for everyone but especially for those on the margins, by creating a fair and equitable property tax. They could make health care more accessible and affordable by requiring all providers and carriers that receive over $100million of Federal transfer payments be required to annually submit a signed partners audit to the legislature—the representatives of the people who themselves are customers, constituents and patients.

Why an audit? It has been estimated by CMS and the Congressional Budget Office (CBO) that there is a 23% fraud rate in the Medicaid system including fraud from patients, providers, and vendors. Total Medicaid spending in our country was over $800billion—almost as much as we spend on our military. In our state, $3.7 billion is spent on Medicaid—State and Federal contributions combined (State funds=$780million).

But here is the rub. The hospital and physician lobbies—The Idaho Hospital Association (IHA) and the Idaho Medical Association (IMA) and large business represented by The Idaho Association of Business and Industry (IACI) are all representing clients whose heals are dug in regarding the status quo for health care spending. The perverse incentives that increase costs to individuals and taxpayers and increase profits to large hospital networks and insurance carriers are only getting worse not better. Supply chain rebates and kickbacks to doctors, hospitals and pharmacy benefit managers are never counted when “fraud” is estimated. Hospitals and Insurance carriers are big businesses that are simply reacting to false economic incentives that increase profits. They rightfully protect their “book of business” but since the affordable care act with Medicaid Expansion and Health Insurance tax credits only 50% more people are now covered than before—and this isn’t counting 12 million immigrants who are still undocumented. 92% of Americans are insured either by their employer or themselves. 28 million people have no insurance. The group of uninsured in every State pays at a much higher rate than the insured. The Wall Street Journal study of thousands of prices at hundreds of hospitals demonstrated that many charge top prices to the most vulnerable patients who must pay cash out of pocket compared to the prices the hospitals have negotiated with insurance carriers. This is true of many hospital systems and providers in Idaho.

One other interesting point about the impact of the ACA. In 2009 when there was an unemployment rate of 9.2% far more people were uninsured—48 million (20%) according to the Government Census Office than today—8.8% uninsured. I made the point in a previous article that from 2016-2020 when unemployment decreased fastest and the labor force participation rate increased the fastest, the percentage of uninsured decreased the fastest. A good economy and job creation did far more for providing coverage and access to individuals than the Affordable Care Act (ACA). Mr. Trump through policies encouraging employment and making the business and individual tax environments better and decreasing regulations on business did more to provide more health care to citizens than the ACA.

So here is what I recommend our legislature do:

  1. Require individual audits for organizations that make more than $100million in transfer payments.
  2. Price transparency from carriers and providers to the public needs to be continued. Neither group is actually complying with the law in this regard.
  3. Today patients (consumer-citizens) can only get the benefit of discounted pricing by purchasing an insurance product. In this regard insurance companies should be encouraged or required to offer products that provide zero benefits, but provide patients with access to the negotiated discounts available to those who have insurance. The carrier would carry no risk and could charge for the service of access to pricing. After a service is rendered the insurance company would receive the bill and be able to certify and verify the prices charged. The bill is then forwarded to the patient who pays 100%. This plan suggested by Prof. Paul Horvitz is good for all parties. The provider gets a patient it may not have, the patient gets the discounted price and the insurance company can charge an “agents fee”. The insurer only handles the paperwork and assumes no risk.

Unfortunately everywhere in government at both the State and Federal Level we see the cost of government going up, the size of government going up, and the intrusion of government into individual families going up. The longer a politician stays in government the more likely they are to forget who they are supposed to service—their constituents, my patients, and not themselves.

I doubt that these types of discussions will be happening at The Governor’s Cup this year where the lobbyists help pay for golf, skeet and trap, food and beverage and who knows what else, for the chance to “schmooze” State Legislators and Government Bureaucrats, and maybe a judge or two.

Are there any Chinese lobbyists in Idaho—registered or not? Rumor has it Eric Sowell was seen at Sun Valley a few weeks ago. Hmmmmmmmmm.

MAGA “Fight Like Hell”

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