{"id":3251,"date":"2011-12-30T14:30:38","date_gmt":"2011-12-30T21:30:38","guid":{"rendered":"http:\/\/stateimpact.npr.org\/idaho\/?p=3251"},"modified":"2012-01-11T12:23:19","modified_gmt":"2012-01-11T19:23:19","slug":"rep-rusche-not-putting-money-back-into-government-services-could-be-penny-wise-and-pound-foolish","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/idaho\/2011\/12\/30\/rep-rusche-not-putting-money-back-into-government-services-could-be-penny-wise-and-pound-foolish\/","title":{"rendered":"Rep. Rusche: Not Putting Money Back Into Government Services Could Be “Penny-Wise and Pound-Foolish”"},"content":{"rendered":"

The Idaho Legislature convenes January 9th.\u00a0 In advance of the session, we interviewed several legislative leaders and asked them about Idaho’s economy and what the state could be doing to boost growth and job creation.<\/em><\/p>\n

\"\"<\/a>

Idaho Legislature \/ State of Idaho<\/p>

<\/p><\/div>\n

Minority Leader Rep. John Rusche (D-Lewiston) was elected to the <\/em>Idaho House of Representatives<\/a> in 2004.\u00a0 A retired physician and former health insurance executive, he served as Senior Vice President and Chief Medical Officer for Regence BlueShield of Idaho and Regence BlueCross BlueShield of Utah.<\/p>\n

Q: <\/span>What are your priorities for the upcoming session?<\/p>\n

A: <\/span>Personally, there\u2019s a lot of issues involving health care, everything from the catastrophic healthcare fund<\/a>, which I\u2019m on the board of, to Medicaid and funding for various health care services that we\u2019ve cut over the last few years.\u00a0 Then, of course, the big one is the health insurance exchange and cooperation with the Affordable Care Act<\/a>.\u00a0 I think that\u2019s going to occupy a fair amount of my time.<\/p>\n

Q: <\/span>Let\u2019s start with the catastrophic health care fund.\u00a0 Currently, it\u2019s overstressed and underfunded.<\/p>\n

A:<\/span> The CAT fund is a very strange creation.\u00a0 It\u2019s really just a financial assistance fund for health care expenses, and to qualify for that financial assistance you have to be indigent, as defined by state law and the county commissioners, and have a health care expense.\u00a0 So, the services are already received by the time someone qualifies for the catastrophic health care fund.\u00a0 It used to be that it was to cover if somebody had an auto accident, or something, in the county, so that the small counties that had financial responsibility would not be hurt.\u00a0 It was a reinsurance mechanism for those expenses.<\/p>\n

Well, as the cost of health care increases and we get more people who are uninsured, the call on that fund has increased.\u00a0 Now, we\u2019re seeing patients that have chronic diseases \u2013 cancer, for example, or heart disease, or some chronic mental health illnesses \u2013 who may not qualify for Medicaid or disability, but don\u2019t have money to pay for the care they need.\u00a0 When you include both the county expenses and the state expenses, last year it was about $78 million.<\/p>\n

[legislator leg_id=IDL000089 align=right]<\/p>\n

Q: <\/span>What can the legislature do about that?<\/p>\n

A: \u00a0<\/span>My belief is that the need for that program goes away significantly in 2014 with the expansion of Medicaid and the premium insurance available through the Affordable Care Act.\u00a0 I think we just have to hold on and see it through for the next two years and then we take that money and use it to fund the state part of the Medicaid expansion.<\/p>\n

Q: <\/span>I expect you\u2019re not in the majority in thinking that way.<\/p>\n

A: <\/span>I would have to say that much of the opposition to anything related to health reform is political and not well-thought-out policy.\u00a0 If we don\u2019t have any alternative and we still have a requirement to cover the health expenses of the indigent, I don\u2019t see any way that isn\u2019t going to continue to increase.\u00a0 There are detriments to the Affordable Care Act, but one of the main values is the extension of coverage.<\/p>\n

Last year we had three bills attempting to nullify \u2013 in Idaho \u2013 the Affordable Care Act. One passed both the House and Senate and was vetoed by the Governor.\u00a0 I think the bigger discussion will be: do we cooperate and develop our own health insurance exchange, or do we hold our breath and just say no, hoping it all goes away?\u00a0 If it doesn\u2019t, citizens in Idaho participate in a federal exchange.<\/p>\n

Q: <\/span>You\u2019re saying it will be a debate between people who say, \u201cLet\u2019s try to design a program for Idaho,\u201d and people who say, \u201cThis is going to get overturned anyway.\u00a0 Let\u2019s not even bother with it.\u201d<\/p>\n

A: <\/span>Yes, except usually the argument is, \u201cIt\u2019ll make the whole plan go away if we just hold our breath and say no.\u201d<\/p>\n

Q: <\/span>And what do you think of that?<\/p>\n

A: <\/span>I think there would be some real problems.\u00a0 One of the things that bothers me most is, right now, for our small group and individual insurance markets, we have two carriers that have most of the business, Regence BlueShield of Idaho and Blue Cross of Idaho.\u00a0 If we did not have a state exchange, their ability to participate in a national exchange that serves 15 or 18 states would be nil. \u00a0Maybe they would end up being acquired by some other national company, but when you get to talking about most of the national companies, they are big, they\u2019re for-profit.\u00a0 The Idaho marketplace would not be their primary focus.\u00a0 Whether you\u2019re talking about customer service or responsiveness to individual community needs, we would not be well served.<\/p>\n

Q: <\/span>What are the other things that you think are going to command a lot of attention in the session at large?<\/p>\n

A: <\/span>The budget \u2013 as I see it there will be angst and discussion, but because the revenues are increasing, rather than decreasing, I don\u2019t think it will be quite as anxiety-provoking, or quite as much a hassle as in years past.<\/p>\n

I think some of the biggest issues will be \u2013 how much goes where?\u00a0 How much goes into education?\u00a0 How much goes into reserve?\u00a0 Because we have virtually nothing left in reserve.\u00a0 And how much goes to replace those services of government that have been cut back so much over the last three to four years?<\/p>\n

Q: <\/span>You\u2019re thinking of Medicaid, I expect.\u00a0 What other programs are you thinking of?<\/p>\n

A: <\/span>Well, I\u2019m thinking particularly of substance abuse and mental health services that are causing a real burden on local governments now \u2013 sheriffs, county courts.\u00a0 It will cost later on, either for incarceration or hospitalization, when we could have used community mental health or substance abuse services.<\/p>\n

Q: <\/span>Are you basing that on anecdotal information?<\/p>\n

A: <\/span>It\u2019s based on anecdotal information and reports from agencies, and also from the regional mental health board<\/a>.\u00a0 I attended a meeting where they presented a survey of law enforcement, prosecutors, community providers, hospitals and Health and Welfare workers on their perceptions of what is going on, and they all are very consistent in the fact that cutbacks have resulted in lowered amounts of community mental health services, and that has backed those patients into the jails, the courts, and into community hospitalization.<\/p>\n

Q: <\/span>Going back to the larger issue of government services that you think have been cut too much \u2013 aside from mental health services, are there other key areas you have in mind?<\/p>\n

A: <\/span>There are.\u00a0 For example, corrections.\u00a0 There are high rates of turnover.\u00a0 For a new corrections officer, it takes training before they can go to work, and if you have high levels of turnover, all you\u2019re doing is spending your salary on trainees rather than on workers.<\/p>\n

I also think we\u2019re seriously behind on higher education.\u00a0 The schools have seen an increase in students because there are no jobs for them, but the cost is getting prohibitive.\u00a0 I\u2019m really looking forward to the results of the Office of Performance Evaluations<\/a> study on barriers to college or post-secondary education because I think it\u2019s going to show that costs are seriously impacting the ability of people to continue.<\/p>\n

Q: <\/span>\u00a0I\u2019ve talked to legislators who say the state can\u2019t start reinstating funding for programs and services, because revenue has recently not met projections.\u00a0 How do you respond?<\/p>\n

A: <\/span>I was of the opinion, last year, that we seriously underestimated what was going to happen with revenue, and I think that\u2019s borne out.\u00a0 At the end of the year, you have what\u2019s left in your bank account, and that\u2019s one-time money.\u00a0 What should you do with that?\u00a0 Well, I think there\u2019s deferred maintenance that you could fund.\u00a0 There\u2019s money you could put back into reserve accounts.\u00a0 The other is looking forward to 2013, if your revenues are already, say, 5.5 percent above what they were the year previously, that allows opportunities to do some changes in the budget.\u00a0 And then there\u2019s additional revenue growth that can be expected.<\/p>\n

I would submit that caution is costing us by requiring us to pay more for incarceration and in-patient services than we would have had to if we had adequately funded other services. \u00a0I think the discussion will be trying to point out how we\u2019re, in some situations, being penny-wise and pound-foolish.\u00a0 I think that a wise look at the budget, a rational look at the expected revenue increase, would allow us to put some money into those services that will save us two or three years down the road.<\/p>\n

Q: <\/span>How about job creation.\u00a0 What is your thinking, at this stage?<\/p>\n

A: <\/span>I think the legislature can assist the Department of Commerce<\/a>.\u00a0 They\u2019ve gotten a good axe to their resources, as well, over the last couple of years.\u00a0 I\u2019m encouraged by the energy of the new director.\u00a0 I think that there are some models around us in other states, including Utah, where they have set up a revolving loan fund for development of business where they have trouble getting commercial loans.\u00a0 There are opportunities, I think, to participate in providing matching funds for federal grants for business development.\u00a0 And one of the things I\u2019ve been pushing for is improving our telecommunications and broadband infrastructure, particularly once you get outside the big city.\u00a0 We need to have good broadband service for our small businesses, particularly. \u00a0I think we should be concentrating on improving Idaho\u2019s image as not being good for telecommunications services.<\/p>\n

What does it take to make business work?\u00a0 What we can do is develop the infrastructure \u2013 roads, bridges, telecommunications.\u00a0 An educated workforce.\u00a0 We can help the businesses find customers through our Department of Commerce, and keep the tax policies stable so people can build a five- to seven-year business plan.<\/p>\n

Q: <\/span>Are these ideas that you think will actually be discussed in the session?<\/p>\n

A: <\/span>I think they\u2019re pretty much big ideas, as opposed to being bills.\u00a0 We\u2019ve had a number of proposals come from our side of the aisle that have met closed doors. \u00a0I think it\u2019s clear that this legislature is much more interested in showing how much they hate taxes and fees and how much they hate the federal government. So I\u2019m not optimistic that it will reach floor debate.\u00a0 But you ask what we should do for job development \u2013 well, that\u2019s what I think we should do.<\/p>\n

This interview has been edited and shortened.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The Idaho Legislature convenes January 9th.\u00a0 In advance of the session, we interviewed several legislative leaders and asked them about Idaho’s economy and what the state could be doing to boost growth and job creation. Minority Leader Rep. John Rusche (D-Lewiston) was elected to the Idaho House of Representatives in 2004.\u00a0 A retired physician and […]<\/p>\n","protected":false},"author":40,"featured_media":3256,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[121],"tags":[235,64,233],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/3251"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/users\/40"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/comments?post=3251"}],"version-history":[{"count":3,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/3251\/revisions"}],"predecessor-version":[{"id":3627,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/3251\/revisions\/3627"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media\/3256"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media?parent=3251"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/categories?post=3251"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/tags?post=3251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}