By JERRY and

CARRIE SCHEID

Special to The Press

Carrie: Was Santa good to you?

Jerry: I got some things I wanted but not the most important one.

Carrie: What's that?

Jerry: What I really want is for the Legislature to close the Medicaid gap.

Carrie: Huh? Why would anyone care about that?

Jerry: It would give the working poor affordable health care. Thanks to the “Affordable Care Act” or “Obamacare,” Idaho has the nation's second highest per capita rate of health insurance enrollments. Unfortunately, 78,000 Idahoan adults can't get subsidized coverage because they are too poor.

Carrie: That makes no sense. The purpose of the Affordable Care Act is to make medical care affordable for lower income people.

Jerry: The problem affects those who make less than the federal poverty level. Medicaid will cover low income children but generally not their parents. A family of four earning over $6,200/year but less than $23,850 gets no health insurance subsidy whatsoever. That's because Obamacare calls for the states to cover those folks by expanding their Medicaid programs. The “carrot” is that the feds would pay almost all those costs in the first few years and 90 percent after that. The Supreme Court ruled Obamacare as constitutional, but it also ruled the states couldn't be forced to expand Medicaid.

Carrie: Let me guess … the Idaho Legislature won't do it?

Jerry: They've killed it two years in a row. Reminds me of Ebenezer Scrooge who said “Are there no work houses for the poor?”

Carrie: Nowadays they're called Walmart and McDonald's. They employ thousands of low wage part-time employees who don't qualify for employer health insurance. Often they work two part-time jobs. What do those folks do?

Jerry: They get the most expensive and least efficient medical care possible. They go to the hospital emergency room because their illness has gotten so bad they have no place else to go.

Carrie: The E.R. is incredibly expensive. Who pays the bill?

Jerry: The first $11,000 is paid by our county indigent fund. In Bonneville County, we taxpayers pay $1 million annually into the fund. Because 11K will not cover, for example, an $82,000 emergency brain tumor treatment, the State Catastrophic Fund, also paid for by us taxpayers, covers some of the bill. The rest gets written off as charitable care by the hospital.

Carrie: And that charitable care ultimately gets paid by us insured folks in the form of higher medical costs and premiums.

Jerry: Exactly. If the Legislature expands Medicaid this year, it would save Idahoans $65 million in state and local taxes alone. Over 10 years, it would save $173 million. Think of the education or road improvements we could do with those funds and/or tax relief. On the human side, it could save the lives of up to 179 of our fellow Idahoans annually, including a large number of veterans. Twenty-six other states have already done it. In the Northwest, both the Wyoming and Utah governors are pushing it.

Carrie: I hear the Idaho Department of Welfare has an entirely new Medicaid expansion proposal for the Legislature this year. It requires more personal and professional responsibility in the doctor/patient relationship. Their goal is to keep people healthier and reduce serious illness. They'd also require some to purchase subsidized private health insurance from the state exchange.

Jerry: It will be an uphill battle because most Republican lawmakers are fearful of being associated with Obamacare.

Carrie: Unfortunately, legislators rarely hear from us average Idahoans who think health care is important.

Jerry: Let's change that by asking folks to contact our legislative leaders listed in the box we included. Let's get health care for Tiny Tim!

Carrie: Because Tiny Tim is a child, he's already covered. Now it's time to cover his hardworking parents Bob & Mrs. Cratchit. Don't they need affordable health care too?

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Jerry is a retired farmer/rancher and native Idahoan. Carrie is a retired nonprofit administrator. They live in Idaho Falls.

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Please contact the legislative leaders below and ask them to cover the Medicaid gap this session.

Governor Butch Otter, governor@gov.idaho.gov or call 208-334-2100

House Speaker Scott Bedke, sbedke@house.idaho.gov

House Health & Welfare Committee Chair Fred Wood, fwood@house.idaho.gov

Senate Pro Tem Brent Hill, bhill@senate.idaho.gov

Senate Majority Leader Bart Davis, bmdavis@senate.idaho.gov

Senate Health & Welfare Chair Lee Heider, lheider@senate.idaho.gov