Testimony of Dr. John Livingston Concerning Medicaid Executive Orders 1115 and 1332


I would like to thank the Committee and the Chairman for providing me with the opportunity to testify regarding my concerns about the legislation surrounding the 1115 and 1332 waivers.

Seven years ago, I was honored to be appointed to the YHI Exchange Board by our Governor and confirmed by the Senate, and honored once again to be reappointed for another term.

Throughout my service on the Exchange Board, I loved the idea that patients could, with a small subsidy, choose to buy insurance to protect themselves and their families against medical catastrophes which would otherwise claim their wages or their wealth. That way, Idahoans had a way to keep their heads above water, and—particularly during the economic downturn—exchange insurance was a bridge allowing families reach a more stable economic position. If you’ll recall, this was a time when unemployment was at 9.4%. Though our circumstances as a state have improved, the exchange still holds an important place for people trying improve their lives and secure their families’ futures. As the economy keeps improving, I continue to hope that our insurance exchange will one day be privatized and run by the broker community. I see this as the best way to offer a wide variety of insurance coverages—including those “non-conforming” products anticipated by our governor’s recent executive order—which are so critical for the security of Idaho’s families and residents.

In light of this vision, I found the presentation on 1/24 to the House Health and Welfare Committee disturbing. I am concerned that the most vulnerable among us—those with chronic diseases who, though no fault of their own, are prevented by their illness from supporting themselves—are being used as pawns. The proposed legislation seems to be an arbitrage of insurance risk by health insurance companies to exchange chronically ill and expensive patients with healthy—and thus less costly—populations within the health insurance market.

It comes down to this: 3,500 chronically ill patients, with burdens like cancer, collegian vascular diseases, and hemophilia, are being asked to remove themselves from the commercial, subsidized insurance of their choice—bid adieu to the doctor and specialized clinic they have likely known for years—and switch to Medicaid. We are told that everyone will have a choice, but not much of one: Move to Medicaid, switch your provider and entire support network, or stay and lose your subsidy.

Simply put, this is cruel, and not in the patients’ best interests. The complex nature of chronic illnesses means that most of these sick patients are currently treated by specialists—they have likely spent years under the care of doctors specifically trained to treat their conditions. Such quality of care will not be found in Medicaid. Medicaid focuses on direct primary care: treating single, specific health difficulties with an eye toward a quick recovery and lower costs, which in and of itself I support. But primary care is wellness-oriented, and thus it is certainly not the ideal situation—or even a good situation—for chronically ill patients in need of long-term treatment.

Director Dean Cameron of the State Department of Insurance argues that health networks are constantly changing, and that the effects of switching from one insurance system to another will be negligible. I respectfully disagree. Each year our health networks become more stable, and those who benefit most from that stability are the vulnerable populations this legislation claims to help. But as I see it, the only beneficiaries of these waivers are the insurance companies who get to move their most costly claimants to a government program, with no regard for the actual preferences and health needs of these patients. We are being asked to stabilize the commercial marketplace on the backs of those who are most ill, and I find it unacceptable, even draconian.

I apologize for not being able to present my testimony in person, but I would very much like to answer any questions you may have, and, if appropriate, I look forward to testifying before your committee at a later time.

Thank you for letting me express my concerns.

Sincerely,
Dr. John Livingston MD FACS

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