The service provider does not get its own line in the federal budget, but accepts Medicaid and funding from other government programs, primarily Title X. Except in extreme cases, federal money already cannot pay for abortions, which made up about 5.9 percent of the services provided by the local Planned Parenthood affiliate in 2016. There are no clinics in North Idaho, and people come from as far as Montana to the local clinics for help, Harms says. “Defunding” the clinics by not allowing Medicaid patients to go there could mean that about 9,500 people treated in Spokane, Spokane Valley and Pullman in 2016 could lose access to care, Harms says. “Other providers cannot just absorb Planned Parenthood’s patient base if it is cut off from federal programs,” Harms writes in an email. “Politicians who want to deny patients using Medicaid from going to Planned Parenthood often insist that other providers will fill the gap, but the experts at the American Congress of Obstetricians and Gynecologists and the National Partnership for Women and Families said it flat out: They can’t.” n
job manning the self-checkout aisle at the Walmart in Lewiston. She says her deductible is so high that she’s considering skipping out on crucial eye injections used to treat her macular degeneration. She already has too much medical debt. Her 51-year-old husband can’t get insurance on her plan. Despite his migraines sometimes resulting in late-night emergency room visits, he doesn’t have insurance at all. “It would be nice if Idaho could make it a little bit more affordable, if possible,” Allen says. Even with the Republican health care reform plan looming, advocates like Lauren Necochea, director of Idaho Voices for Children, are urging Idaho to expand Medicaid while it still can. “Having health care for a couple years is better than not having any health care for the foreseeable future,” Necochea says.
CLOSING THE GAP
But Malek has long argued that Idaho politicians should focus on fixing the root causes of rising health care costs. Low-income, uninsured Idahoans end up flooding expensive emergency rooms when they should be going to the primary care doctor, driving up costs for everyone. “Minor problems become bigger problems, so the system has to compensate,” Malek says. “That’s a huge difference between Washington and Idaho. Our safety net system is the emergency room.” Even if Idaho did choose to expand Medicaid, Malek says there simply aren’t enough primary care doctors in the state, especially in rural areas. Even with insurance, the wait to see a doctor can be a long one. “If your choice is wait three weeks or go to the ER, you’re going to go to the ER,” he says. Malek and other Idaho Republicans have sketched out a plan to address the problem at the state level: Dramatically increase the number of primary care doctors by increasing the number of family medicine residency slots. Create a state-funded student loan forgiveness program for doctors who agree to practice medicine in underserved populations. And finally, use state funds to directly pay primary care providers and health clinics to offer more charity care to the uninsured. “This is not a cure-all,” Malek acknowledges. It wouldn’t address the needs of low-income Idahoans who need to see specialists or go to the hospital. But it’s a start, he argues. The plan still faces a steep climb before becoming law. On Monday, an attempt to spend $10 million in tobacco settlement funds to cover primary care for about 15,000 of the most chronically ill uninsured Idaho residents died in the Senate. But for Malek, that climb is necessary. “The cost of health care continues to skyrocket,” he says. “The cost of health care is hurting at home.” n
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MARCH 23, 2017 INLANDER 15