"I actually feel fairly optimistic -- some people think I'm crazy -- but I'm optimistic that we're ready to start making some significant changes that will be good for all of us," Armstrong told the Statesman editorial board. "It's going to be a bumpy road. I didn't say it's going to be easy."
Armstrong said it's not clear yet what a Trump administration and the Republican-controlled
-- Your Health Idaho, the state healthcare exchange created under Obamacare -- the 2010 Affordable Care Act -- will continue to operate.
-- A legislative committee will propose, and the Legislature will adopt, some lesser, state-funded option to address care for uninsured Idahoans, but it won't meet the needs of all 78,000 in the so-called insurance gap group.
-- Obamacare will change and get a new name. What it will become, and how long that will take, is still anyone's guess.
Following are excerpts from the 75-minute meeting, edited for clarity, beginning with Armstrong describing what might policy might emerge from the Legislature next year. With the loss of ACA-supportive lawmakers in this year's primary and general elections, he said the body "had gone a little more conservative."
Statesman: Has there been any talk about getting rid of the state exchange?
Armstrong: No. I have heard none of it. The state exchange has been working very well....
ACKNOWLEDGING A PROBLEM
Statesman: Is there going to be a state solution for the gap group?
Armstrong: The problem is still there. The good news is that (legislative) committee has universally acknowledged that it's a problem, which is progress. They know it's not going to go away. They want an
Now if it is as basic as the Primary Care Access Program, that's fine. At least they're doing something to improve the quality of life of those individuals that don't have the financial resources to have insurance. So that's a responsible thing to do, and I don't think the election allows them to stand down on that issue, because the gap is not going to be filled with anything that we've seen out of the election. ...
Trump (has said) he was going to use
MORE FUNDING TO
Statesman: If it came as a block grant, would
Armstrong: I don't know what the terms of engagement would be. It would seem unlikely that a block grant would be based on a national formula. They tend to look at what you're doing locally, and what you've been spending locally, and then just reconstitute what you're already spending.... It's way early (to know), and I think it's years out.
Statesman: So what do we do between now and then?
Armstrong: I think we look at this (legislative) committee and say, what are you going to do within the state of
Statesman: What do you think the forecast is for health insurance in
Armstrong: I think the insurance exchange will probably stay in place because it's a tax credit, and everything that we've seen favors tax credit concepts. ... As far as reforming the ACA, I think they'll have the ability to adjust it (in
FUTURE COSTS, POLICY CHANGES
Statesman: What do you see now in the next four or five years in terms of health care inflation?
Armstrong: I can only speak to
Statesman: Trump has been talking about allowing insurance companies to operate across state lines. If that happens, what are the implications?
Armstrong: I never understood that statement at all. It makes no sense to me. It's the silliest argument I've every heard. Think about it: Insurance is regulated by the states. Is he suggesting that we're going to federalize health insurance? It doesn't seem like a
Statesman: What does a replaced Obamacare look like? What survives, what doesn't survive? And is it in phases? What do you expect?
Armstrong: I have not a clue. Everybody that uses that language never provides any detail as to what the replacement product is. They dance around and say it's going be wonderful, it's going to be less expensive -- oh, a Health Savings Account. Well, we've been doing Health Savings Accounts in
This notion of skin in the game I think is kind of mean-spirited. Think about it. Those poor individuals out there, the gap population, not only do they have skin but they've got all their contents (in the game) too. They have nothing, guys. And this is just silly to think, oh, well, we need to have a 30 or 40 percent co-pay and that's going to some way make them more responsible? No.
Statesman: What are some of the options then that are going to come in to replace it?
Armstrong: Part of ACA was essential health benefits. That's really pretty generous. ... That was a blow to being able to design products with lower prices because you weren't able to segregate out certain services and have (the consumer) decide. ... So if they repealed ACA, then I would assume that we could start seeing benefits vary dramatically, and we'd start maybe skinnying down the benefits package to get a lower price. ..."
(Armstrong told the Statesman that kind of change would force consumers to be more educated about what plans offer and which one they choose.) I think it's been difficult for all of us to understand what the repeal and replace actually means. My guess is the replace will be something that has a lot of features that we've seen before, but it will be described differently and that's acceptable, too. It'll be called something else.
CHARITY AND UNCERTAINTY
Statesman: Does charity play a role, where they can come to the rescue for the people in the gap?
Armstrong: Charity is important. ... But it hasn't been growing. I've talked to a number of charitable organizations about what their state of affairs is and they're always on the ragged edge of being able to meet the current needs with the contributions they have. I don't know where this flood of new philanthropy's coming from. ...
Statesman: Who's leading the advocacy for this?
Armstrong: Well, it's the folks that don't like government: If you don't want government to do it, well then get the private sector to do it. But charity only happens when there's surplus that can be given and given freely. And we look at household income in
Statesman: How do we navigate the next few months?
Armstrong: We're all in that same predicament of not knowing what might happen. But I think we talked today about the fact that you can't just blow up something and then someday park something back in. It's too disruptive. So it will be incremental. ...
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