MOSCOW — As she got older and began paying more attention to the world, Emily Strizich learned a valuable life lesson.
Strizich came to understand that complaining doesn’t really accomplish much. You can’t just take to social media, tweet your outrage at the latest injustice, and expect things to get better. If you want to make a difference, she realized, it takes a bit more effort.
“If you want to change the world, you have to work for it.”
That’s how Strizich phrased it recently, standing outside the Latah Community Health clinic next to her battered green “Medicaid mobile.”
As co-founder of Reclaim Idaho — the group behind the Prop 2 Medicaid expansion initiative — Strizich has learned a thing or two about working for change. She’s spent the better part of the last year knocking on doors, listening to people’s stories and collecting the signatures needed to qualify the initiative for Tuesday’s general election ballot.
If approved, the measure would extend Medicaid eligibility to all Idahoans who earn less than 138 percent of the federal poverty level. That includes about 62,000 working adults who are in the Medicaid gap — earning too much to qualify for government health care, but too little to receive subsidized health insurance through the state exchange.
The topic inspires strong sentiments among many Idahoans, both for and against. Some view health care as a basic right. Others see Medicaid as a more efficient alternative to the state’s costly indigent system. For opponents, the measure is just another welfare scheme, a doomed and misguided attempt to increase public dependence on government and lift people out of poverty through wealth redistribution.
Strizich, 35, didn’t set out to create this lightning rod. As a pediatric occupational therapist — someone who helps children develop the skills they need to lead independent, productive lives — she often deals with low-income families who lack health care. But she never imagined herself playing a role in addressing that need.
“I would talk with people in the gap and think to myself, ‘something ought to be done,’ but I didn’t understand the history of the issue,” she said.
It was education, not health care, that first got Strizich out knocking on doors. Her husband, Garrett, grew up in Sandpoint. In 2017, dismayed at the prospect of another failed school levy, they contacted childhood friend Luke Mayville and set out to boost public support for the measure. Joined by about 60 other volunteers, they knocked on 3,000 doors in one weekend, then cheered as the levy sailed to victory.
“After that, we realized there was a lot of pent-up energy,” Strizich said. “People wanted to be involved, so we started looking around at what’s next.”
Given the Legislature’s continued refusal to address the plight of the Medicaid gap population, they turned their attention to health care. They went back to knocking on doors, listening to people’s stories about the choices they had to make — between medicine and food, getting treatment or keeping their homes, between working to pay the bills or losing their jobs because a chronic illness had become too severe.
“I hear those stories at least once a day,” Strizich said. “To know that a better option (Medicaid expansion) is on the table, but that politics gets in the way, is very frustrating.”
Now, because of the work of she and hundreds of other volunteers put into this issue, Idaho voters can weigh in on the matter. They can help decide if providing health care for the working poor is a proper role of government.
“I respect those who want (limited) government,” Strizich said. “But I want to save lives. That’s my ideology.”
Opponent: It’s the wrong approach
Sen. Steven Thayn, R-Emmett, agrees something should be done to address the health care needs of the gap population, but he sees Medicaid expansion as the wrong approach.
Thayn is one of nine senators and 21 representatives — nearly a third of the Idaho Legislature — who have urged voters to reject Prop 2. He also wrote a collection of essays on the topic, titled “Road to Venezuela: The unintended consequences of Medicaid expansion.”
“The greatest problem I see with Medicaid expansion is that we are actively seeking more individuals to sign up for another flawed anti-poverty program that has the real potential to trap them in perpetual poverty,” he wrote in the introduction.
Like Strizich, however, Thayn isn’t content with mere complaining. Over the last five years he has proposed a number of alternative, small-government approaches to health care that, while not as comprehensive as Medicaid expansion, are more consistent with his conservative values.
During the 2018 session, for example, he authored legislation to create a small pilot project that would provide direct primary care services to people for as long as 10 months, in exchange for them attending financial literacy or health coaching sessions. The intent was to provide access to care, while also educating people in skills they could use to move themselves out of poverty.
Although the pilot program was only designed for 150 people, Thayn believes a full-scale model — complete with a new “medical procedures” fund to pay for nonprimary care hospitalization and surgical needs — could be built for about $60 million. Ignoring potential savings from the indigent care system, that’s roughly how much Medicaid expansion might cost the state.
Thayn acknowledged that his idea isn’t a perfect solution, but he thinks it’s better than perpetuating an antiquated “War on Poverty” approach that increases government dependence.
“The solution lies in empowering people to solve their own problems,” he said.
The fate of the bill, however, illustrates the legislative impasse that has consistently blocked action on the gap population: The measure passed the Senate unanimously, but failed to get a hearing in the House.
For six years, Thayn said, lawmakers “of a liberal persuasion” have held out for full Medicaid expansion, while far-right Republicans insist health care for the poor isn’t a proper role of government. There haven’t been enough “proactive conservatives” in the middle to break the stalemate.
In his estimation, though, if a limited-government solution isn’t found to a problem people want resolved, then they’ll turn to a big-government solution.
“The issue of providing health care to the poor in a more robust way has been raised, and it has to be dealt with,” Thayn said. “Just saying no isn’t an option.”
‘Government created this problem’
But saying no to more government is exactly what Idaho Freedom Foundation President Wayne Hoffman thinks voters will do on Tuesday.
“Voters aren’t clamoring to expand Medicaid,” he said. “The only ones clamoring for expansion are hospitals, the Idaho Medical Association and a left-leaning organization. Voters just want their health care costs reduced and to stop paying so much for insurance.”
Hoffman worked as a television and print reporter for 10 years before switching to politics. He served as communications director for Idaho Congressman Bill Sali before helping launch the Freedom Foundation in 2009.
Having watched the Idaho Legislature and observed federal agencies for more than 20 years, he said, “I’ve never encountered a government program that delivered as promised, or that didn’t help someone at the expense of others.”
Hoffman’s answer to the health care crisis is to return to the pre-government involvement days of the early 20th century. He believes the problem can be resolved by expanding charity care and promoting free-market solutions that increase competition, drive down costs and improve quality.
His insistence that churches and community groups can effectively care for people with cancer or chronic illnesses has been widely panned, but he says that’s what they used to do.
“Historically, when people had a need, they didn’t go to a government office to meet that need,” Hoffman said. “They turned to their family or church or community. Over time, the government took over that role and lessened the need for charities to engage. Now, people have no idea what these groups are capable of.”
The Legislature has plenty of options to drive down health care costs as well, he said. For example, lawmakers could reduce continuing education requirements for doctors, so they don’t have to spend as much time in the classroom. They could also provide voluntary immunity from malpractice claims, which would reduce or eliminate a major operating expense.
“Government created this problem, and more government isn’t going to solve it,” Hoffman said. “What we’re after is reducing the size of government — and we’ll still be after that when Prop 2 fails.”
Survivor supports Prop 2
Big government, limited government, no government: Jenenne Newbre isn’t sure which direction voters will go with this Goldilocks question, but she knows where she stands.
Newbre spent three years curled up on her couch, struggling with the effects of what turned out to be a brain tumor. She couldn’t afford insurance, couldn’t lift her head and didn’t know where to turn. Then Latah Community Health opened its Moscow clinic.
“I got an appointment, and they immediately found the tumor and helped me get treatment,” she said. “They saved my life.”
Now Newbre serves on the board for Latah Community Health, which provides medical, dental and behavioral health services to more than 3,000 people each year, regardless of their ability to pay.
Her story illustrates the power of Hoffman’s charity care, as well as Thayn’s emphasis on primary care and Strizich’s focus on saving lives. It could be used to support any number of solutions to the health care crisis — but for her only one alternative makes sense.
“I was a ticking time bomb. Now I’m thriving,” Newbre said. “We need to pass Prop 2 so other Idahoans can thrive again.”
Spence may be contacted at bspence@lmtribune.com or (208) 791-9168.
