“The need for price transparency and disclosure has emerged as one of the hot topics in consumer-directed health care,” said Rep. Bob Nonini, R-Coeur d’Alene, who sponsored the plan. It would launch a website next January that would list the cost of the 25 most common procedures each health care provider performs and insurance companies’ reimbursement rates for the 25 most common procedures.

The Idaho Department of Insurance would run the website and data collection, with an estimated cost of $15,000 a year. Nonini said the website could look like a similar Utah website and that at least 30 states have similar transparency measures.

“I don’t think we’re really plowing new ground here,” Nonini said. The House Business Committee approved his legislation on a 10-6 vote.

Opponents to the plan were concerned about the potential cost and the added mandate to health care providers. House Minority Leader John Rusche, D-Lewiston, a former executive with the insurance company Regence BlueShield, said the intention of the website could be an incredible tool, but the specific plan is flawed. He said the price tag for the system could be several hundred thousand dollars a year, which would be 10 times what Nonini estimated. He said Utah’s system had initially cost $2.5 million.

Toni Lawson with the Idaho Hospital Association told lawmakers it’d be hard for hospitals to collect the data because legislation asks hospitals to do something with no detail about how to do it or how to pay for it. She also said that the new website’s data collection could be considered an unfunded government mandate.

Lawson and officials with the Idaho Medical Association, which represents doctors, and Regence said they support transparency efforts, though they’re neutral on Nonini’s legislation. All offered potential problems with the plan.

Nonini said the requests from changes from the medical community amounted to stalling, and that in other states it took action from lawmakers, not insurance companies, doctors or hospitals, to start the transparency websites.

“Any information is better than no information, and right now there’s no information in Idaho,” Nonini said. “I don’t think it’s worth waiting another year and not moving forward with more health care transparency.”

Department of Insurance Director Bill Deal said he first learned about Nonini’s legislation last Friday, but said his department can handle the task at the $15,000 cost Nonini mentioned.

“If we’re just going to deal with the pricing of the procedure, that’s something we can put together.” Deal said he already has the staff to create the website, and that it would take a few months to see whether the department could get the website up by the proposed deadline of next January.

The bill was signed by Gov. Butch Otter, who received national attention for doing so.  Otter, facing a re-election challenge from Democrat Keith Allred, believes that the federal government cannot force anyone to purchase any product or service.

Allred, in a press conference several days after the signing, said that Otter’s behavior wouldn’t help Idahoans at all.  He said that he would work within federal health care reforms to develop a state health system that would perform better than any federal program that could be devised.

Instead of bucking the federal system, Allred said he would work to create a state exchange, based on free-market principles, which would help lower the cost of overall care.  He said that it is critical that costs are addressed in statewide reforms, but added that the markets must be involved.  ”I don’t think all the answers are government-run, by a long shot,” said Allred, who does not favor government price controls on health products or services.

The Democrat’s system would focus on preventative and primary care as a means to avert higher costs in catastrophic care.  To do that, Allred explained, Idaho needs to put a large emphasis on training nurse practitioners, who provide basic health services at lower costs than doctors.

Here are Allred’s full remarks to IdahoReporter.com on his ideas for a state health system:

Otter has consistently rejected the majority of Allred’s ideas, saying that health care reforms need to be overturned.  Otter explained in an interview with IdahoRepoter.com that he also believes in a “homegrown” health system and that the state has been working to increase nursing schools to allow more health providers to receive training in Idaho.

On Allred’s plan for a state-managed health system, Otter says that the Democrat’s plan would likely be worse, in his opinion, then federal reforms. ”It’s been my experience that you’ve got to have a system that’s as bad as – or worse than – the federal government’s answer,” concluded Otter.

Here are Otter’s full remarks on health care in Idaho:

Otter and Allred, along with three other candidates, square off in the polls Tuesday.

The two candidates both said the American economy is in trouble, and offered some similar policy changes they see as solutions. Both talked about cutting federal earmarks and reforming federal entitlement programs, which include Social Security and Medicare and other legal benefits.

Both also agreed in generally supporting the war in Afghanistan, though Labrador said he’s heard from parents of soldiers who are concerned. “These kids are in harms way and we need to have a definite mission,” Labrador said. Minnick said that mission should be denying the terrorist network Al Qaeda a sanctuary in the country.

While Labrador and Minnick sparred over a new Minnick commercial condemning Labrador’s work as an immigration attorney, both spoke briefly about how they’d fix immigration, mentioning the need for a secure border and a guest worker program. The candidates disagree over what to do with illegal immigrants currently living in the U.S. Labrador also said that, given his background in immigration law, he’d work on a national solution to the issue in Congress.

Minnick twice tried to paint Labrador as a fringe candidate for views including tighter limits on abortion rights, eliminating the U.S. Department of Education, and questioning the U.S.’s role in the United Nations.

“A person this far out of the mainstream is going to have almost no influence in an evenly divided Congress where people have to work together to solve the real problems involving America,” said Minnick, who called himself a centrist.

“The people of Idaho like my views,” Labrador said. “They support me, and you will learn about them on Nov. 2.” He also said he can work well with Democratic lawmakers, even if they don’t see eye to eye on policy issues.

The two candidates also disagreed on a federal wilderness plan backed by Rep. Mike Simpson. Minnick supports Simpson’s efforts on the Central Idaho Economic Development and Recreation Act (CIEDRA), while Labrador opposes the plan, as does Gov. Butch Otter and Sen. Jim Risch.

“We need to oppose this legislation,” said Labrador. “Sometimes when you have a half a loaf, it’s just a half-baked solution.”

Minnick called CIEDRA a common-sense solution that Simpson has worked on for years. “You can’t please everybody on everything,” he said.

Labrador and Minnick also disagreed on how to fix how elections are paid for. Minnick called the Citizens United Supreme Court case, which allows corporations and unions to spend unlimited amounts of money without reporting requirements, the worst decision since the Dred Scott case, which maintained slavery.

“It is a bad decision and it is turning our elections over to the highest bidder,” Minnick said.

Labrador said he was in favor of the Supreme Court’s ruling, but said all political contributions should be reported within 24 hours. “I think the finances should be unlimited, but they should be disclosed,” Labrador said.

On health care, the candidates reiterated their different approaches for fixing legislation approved by Congress earlier this year. “We have to start all over again,” said Labrador. Changes he’d like to see include letting companies sell insurance across state lines and tort reform to limit lawsuits against doctors.

Minnick, who also favors tort reform, said he’d prefer repealing portions of the plan, not the whole law. “Let’s keep what’s good and repeal what’s bad.”

The debate, hosted by the City Club of Boise and soon to be rebroadcast by Boise State Public Radio, comes just days before votes in the 1st District will be tallied.

Allred, in an interview with IdahoReporter.com, explained how he would govern if elected to the state’s highest office on Nov. 2.  Allred said that he would approve a plan to collect online sales taxes, examine tax exemptions, would find ways to provide affordable health care to residents of the state using free market techniques, and make “strategic investments” into education to improve public schools in the state.  Allred also discussed a supporter of Republican incumbent Gov. Butch Otter supporter accusing the Democrat of bringing religion into the gubernatorial contest.

Sales tax exemptions

A focal point of the Allred campaign has been sales tax exemptions, special state laws that allow certain businesses or transactions to forgo payment of any sales taxes.  Allred has taken heat from business groups around the state because they say he has flip-flopped his positions on the issue, saying at one debate that “all exemptions are on the table,” while proclaiming at another that some larger exemptions would remain in place.

Allred explained to IdahoReporter.com that all exemptions will be up for review, but that a consensus must be found among Idahoans about which allowances should be closed and which should remain.  Those that receive higher than 60 percent support among citizens will remain in place, while those that receive less approval would be closed.

Strategic investments

Allred said in one campaign television advertisement that if elected, he would make strategic investments into the public school system in Idaho.  When asked to define the investments he would make, Allred offered no set proposals to improve education, but rather said he would look to schooling systems that have been proven to work over the years and implement ideas from those into Idaho’s schools.  “Spending money on the most cost-effective investments, the best programs out there, that makes all the sense in the world,” said Allred.

Religion

At a rally in Boise last week, Republican mega-donor Frank VanderSloot accused Allred of using religion to garner votes.  Allred, a member of the Church of Jesus Christ of Latter-Day Saints (LDS), commonly referred to as the Mormon church, swiftly rejected that notion, saying that it was disappointing that his faith was brought into the race.  Allred told IdahoReporter.com that the Otter campaign also brought in former presidential candidate Mitt Romney, a Mormon, to boost the Republican’s prospects with voters of the LDS faith.  “So who is playing the Mormon card in this race?” questioned Allred.  “It’s the Otter camp, not me.”

Transportation funding

The Democrat has made transportation funding one of the central issues of his campaign.  At a press conference in August, Allred proposed cutting the gas tax by 3 cents while increasing fees on heavy trucks.  His plan was based on a study conducted by the Idaho Transportation Department that showed the light vehicles are overpaying for road use, while heavy trucks are underpaying for the wear they put on state roads.

Otter attempted to push through a 1-cent gas tax increase in 2009, along with a hike in registration fees.  After both plans were soundly defeated by the Legislature, Otter formed a task force to develop alternative solutions to transportation funding needs.  Allred said the Republican governor is using the task force to duck the gas tax issue and shield himself from taking a position on more tax hikes.  “Does he still want to raise the gas tax?” questioned Allred.

Online sales taxes

At a debate last week, Republican Superintendent of Public Instruction Tom Luna, a Republican, said the state must look into collecting online sales taxes on purchases made out of state to bolster education funding.  Allred said he supports the concept of collection of the tax, but would use proceeds from funds collected not to pay for education, but rather to lower overall tax rates for families in Idaho.

Health care

Shortly after Otter signed off on the Idaho Health Freedom Act, a piece of legislation allowing the state attorney general to sue over federal health care reforms passed in early 2010, Allred held a press conference in the Idaho Capitol on the system he would like to see implemented.  At the event, Allred explained that he would like the government of Idaho to work within federal health reform guidelines to most effectively manage health care and bring down costs.

In talking with IdahoReporter.com, Allred said that private interests in the health care sector must collaborate with government to create a system that helps provide affordable care for all citizens. He also says the state must “ramp up” training of physician’s assistants to bring down health care costs.

Allred faces Otter, Independent Jana Kemp, Independent Pro-Life, and Libertarian Ted Dunlap at the polls Nov. 2.

An effort to remove the tax reporting requirement failed in the Senate earlier this week.  Simpson signed onto a discharge petition in the House.  That petition currently has the signatures of 93 House members and needs 218 for the repeal efforts to move forward.  Democratic Rep. Walt Minnick has not yet signed onto the petition.

Simpson’s news release is below:

Idaho Congressman Mike Simpson joined over 70 of his republican colleagues in signing a discharge petition for H.R. 5141, the Small Business Paperwork Mandate Elimination Act. Representative Daniel Lungren (R-CA) introduced H.R. 5141 on April 26, 2010.  This legislation would repeal the expansion of information reporting requirements for payments of $600 or more to corporations included as part of HR 3590, the Patient Protection and Affordable Care Act.

“This requirement must be repealed,” said Simpson. “During these difficult economic times, we should not be creating new unnecessary, expensive and burdensome regulations on small businesses that they cannot afford. We should repeal this provision and instead focus on promoting measures that would encourage small businesses to grow and create jobs.”

The Internal Revenue Service’s own National Taxpayer Advocate highlighted several problems with this requirement in a recent report:

• “[T]he new reporting burden, particularly as it falls on small businesses, may turn out to be disproportionate as compared with any resulting improvement in tax compliance.”
• “[S]mall businesses may have to acquire new software or pay for additional accounting services, incurring additional costs.”
• “In our view, it is highly likely that the IRS will improperly assess penalties that it must abate later, after great expenditure of taxpayer and IRS time and effort.”
• “[S]mall businesses that lack the capacity to track customer purchases may lose customers, leaving the economy

with more large national vendors and less local competition.”

The National Federation of Independent Business says this provision will have a “direct negative impact on small businesses.”  In a statement, the increased costs and burdens resulting from this 1099 provision, which was created without any input or discussion from the small business community.

When a majority of Members of Congress sign the Discharge Petition for H.R. 5141, it will force House Leadership to bring the bill to the floor for a vote.

AARP Idaho, which serves people in the state 50 years or older, is calling its online and print voters’ guide the largest in the state.  Several other organizations have posted candidate questionnaires discussing other political topics.

“Our efforts are going to help voters cut through the political campaign clutter and get right to the issues,” spokesman David Irwin said Thursday.

The online guide currently has information for state legislative races, and the contests for governor and lieutenant governor.

AARP Idaho State Director Jim Wordelman said the response rate from office seekers has been good.

The candidates’ responses are listed next to AARP’s position on an issue.  The group favors repealing a law approved earlier this year without Gov. Butch Otter’s signature, that gives medical professionals conscience rights, but could cause some workers to not honor patients’ end-of-life care instructions.  AARP Idaho also favors more limits on political campaign contributions.

AARP will also soon release a similar guide for candidates for the U.S. Senate and House of Representatives.  One of the issues Wordelman said the group is asking congressional candidates about is whether they support higher funding for doctors who treat people on Medicare and Medicaid.

Other issues on AARP’s list include supporting Social Security, improving the economy, and  tougher penalties for Medicare fraud.

Wordelman said the group focused on a voter information guide because of the importance of this year’s election.

AARP is also planning events in all 35 legislative districts.

Other websites and  newspapers are also publishing voters’ guides to candidates.  Among those currently available are the Idaho Voters Guide from the Cornerstone Family Council, the Gem State Voter Guide from Idaho Chooses Life and the Idaho Freedom Foundation, and Project Vote Smart’s Political Courage Test.

The partisan fight stemmed over a requirement that businesses file 1099 tax forms for payment, including to employees, of more than $600.  Neither plan is currently moving forward in the Senate.

Republicans, led by Sen. Mike Johanns of Nebraska, tried to repeal that reporting requirement completely as the Senate crafts new legislation designed to help small businesses.  Democrats, led by Sen. Bill Nelson of Florida, backed a plan that would roll back the reporting requirement to purchases over $5,000 and exclude companies with 25 workers or fewer.

Crapo and Risch backed similar legislation from Johanns in July.

Crapo said he’s disappointed the GOP plan failed.  “This is not the time to further demand that small business fill out extensive forms for every small transaction,” he said in a prepared statement.  “This provision endangers small business, the main economic factor in all new job creation, and it must be repealed.”

Risch said the tax reporting requirement for businesses would create a mountain of paperwork.  “Even the IRS is skeptical, saying it cannot handle the expected wave of forms,” he said in a prepared statement.  “We need to enact policy to encourage small business owners to expand, not tie their hands with more Washington-based regulation.”

Neither of the failed amendments received the needed 60 votes to pass.  Seven Democrats voted for the GOP-backed plan, while no Republicans backed the plan favored by the White House.

The U.S. Chamber of Commerce, a large association for business interests, sent a letter to members of Congress supporting the repeal effort.  Local chambers representing Coeur d’Alene, Meridian, and Pocatello signed on to the letter.

Reps. Mike Simpson and Walt Minnick back legislation similar to Johanns’ plan that is currently stalled in a committee in the U.S. House of Representatives.

“There is a critical shortage of primary care physicians in Idaho, and the foundation’s donation is one way we can help make a difference,” said Ray Flachbart, the chairman of the Blue Cross of Idaho Foundation for Health, which will make similar donations the next two years.  Flachbart formally made the first donation in the office of Gov. Butch Otter this week.

Otter told IdahoReporter.com that though all of the U.S. is facing a shortage in primary care doctors, Idaho’s geography makes it tough for doctors to serve all of the state.

The event in the governor’s office didn’t include a financial commitment from the state.  The Idaho State Department of Education has a Rural Physicians Incentive Program scheduled to start making payments to new doctors in rural areas with debt from medical school.

Otter said that the economics of becoming a doctor, including student debt and low payment for government-backed medical care, lead many into specialty care rather than primary care.

Video-Otter2

Dr. Ted Epperly, the CEO of FMRI, said medical school students graduate with an average of $150,000 in debt.

FMRI’s program requires new doctors to train in three different rural Idaho cities during their three-year residency.  The grant money from Blue Cross will pay for some of their salaries and benefits while working in rural Idaho.

Epperly said the grant money will help get family care doctors into underserved areas.

FMRI has work sites in 27 cities for its residents to train.

AARP Idaho, which represents older Idahoans, has called the doctor shortage one of the key issues facing the state.

Idaho reimburses local health care providers for Medicaid costs using its Medicaid Management Information System (MMIS).  The system pays out an average of $24 million a week to Medicaid vendors.  Medicaid provides insurance to 217,000 Idahoans who are children from low-income families, have a disability, are elderly, or are pregnant and low-income.

The state started using a new MMIS program run by the private company Molina Healthcare in June.  Problems with the new system have led to state payments taking longer than usual.

The late payments caused by the new system put a tighter squeeze on some Medicaid providers, since the state had planned to delay Medicaid payments for the last three to four weeks in June to balance the state’s budget.  That means some businesses’ reimbursements from the state in July took longer than expected.

Otter said the rollout of the new MMIS hasn’t gone as planned.

Otter, Molina Healthcare CEO Mario Molina, and Dick Armstrong, the director of the Department of Health and Welfare, met with Medicaid provider groups Monday to discuss the problem.  Molina said he’s sorry for the problems with the rollout of the new system.

Molina Healthcare is based in California and operates in 16 states.

Molina said the company’s system is sound, but that it was understaffed to serve Medicaid providers.  The company will add 48 more employees.  Many of them will work in the company’s call center to handle issues from health care providers.

Molina said he’s dedicated to ending the delayed payments.

Armstrong said the state expects to be back to normal for reimbursements within two months.

Otter said he’ll hold Molina accountable, but isn’t turning back on the new MMIS, which was mandated by the federal government, which pays the large majority of Idaho’s Medicaid costs.

“One option we didn’t have was going back,” Otter said.  “The only option we had was ‘make it work.’”  The governor also said he’s encouraged that Molina understands the problems with the system.

Armstrong said the state has identified 18 fixes to the Molina-run system, and that some of them are already in place.  The rest are scheduled to start in the next 60 days.

Armstrong ordered extra payments to providers while problems with the system were addressed.  He said any provider that is overpaid won’t be penalized unless there is proof of fraud.  DHW would work out repayment plans with any providers who do receive more than they should through the Medicaid program.

“I suspect that Congress is going to be dealing with health care reform for the next 10 years,” Minnick said Wednesday during a call-in show on KBOI in Boise.

All of Idaho’s congressional delegation, including Minnick, voted against the health care law passed by Congress in March.  The state of Idaho is suing part of the law that mandates citizens to buy health insurance.

Minnick said that he thinks Congress will tackle health care next year, after the Nov. 2 election.  His strategy is to fix the legislation, removing problematic parts of the plan and taking care of things that weren’t in the plan, like tighter controls on the cost of health care.

“We are looking at things where Republicans and Democrats agree make no sense,” Minnick said.  “There’s very little cost control in the bill.”  Minnick also said he thinks the current law would likely add to the national debt, because Congress could hold off on funding reductions to Medicare scheduled to pay for expanded health insurance.

Minnick is working on several pieces of health care legislation, but hasn’t signed a discharge petition for a plan to repeal the health care law.  “This is mostly political show,” Minnick said about the petition.  “The Congress is not going to repeal it.  It’s an issue for the next Congress.”

Rep. Mike Simpson signed the petition to repeal the health care law, introduced by Rep. Steve King, R-Iowa.  Currently, the petition has 170 signatures from House members and needs 218 before the health care repeal could move forward.

Both Minnick and Simpson also voted to repeal the individual mandate to buy health insurance, an effort that ultimately failed.

During the radio show, Minnick condemned the current state of Congress, saying that the body has left too many unsolved problems, including illegal immigration, the rising cost of college, and lowering quality of U.S. highways.

“The federal government ought to get on with the job of securing the borders,” he said.

Minnick also said one of the issues looming before Congress before the end of the year is whether to extend the Bush tax cuts.  Those tax cuts, originally passed in 2001 and 2003 and benefit mostly higher income earners, are set to expire at the end of December.  Minnick said the likely options on the table are to extend all of the tax cuts or pick and choose which ones to keep.

“Nobody wants all of these tax cuts to expire on New Year’s Eve,” he said.  He favors keeping the tax cuts in place as long as the economy continues to sputter.

Minnick’s challenger in the Nov. 2 election, Republican state Rep. Raul Labrador of Eagle, will appear on KBOI Thursday afternoon.