This document provides a historical overview of healthcare policy and programs in the United States from the 1930s to present day. It discusses the establishment of key programs like Social Security in 1935, Medicare and Medicaid in 1965, the Children's Health Insurance Program (CHIP) in 1997, and the Affordable Care Act in 2010. The document also outlines the goals and funding mechanisms of these major policies, and describes optional and mandatory benefits covered by programs like Medicaid. It analyzes factors that necessitated healthcare reform over time and how policies have attempted to address issues like the growing uninsured population.

1. Historical Background of the
Policy
Problems that
Necessitate the Policy
Policy Description
Policy Goals
Funding
Dawn R. Juker
Healthcare Policy Analysis

2. NEGATIVE CONSEQUENCES
Reproduction - Historical Overview
WHERE DO WE GO FROM HERE?
Lauren Necochea – Idaho Kids Count
WHAT’S THE OPPOSITION SAYING?
HOW DOES THE U.S. STACK UP AGAINST...
Canada?
Sweden?
WHAT IS IDAHO DOING ABOUT HEALTH CARE?
Exchange
CAT & County Indigent Fund
HISTORICAL OVERVIEW
What happened?
WHAT PROGRAMS TRIED TO FIX THE PROBLEM?
What do they do? How is it distributed?
Who gets what? How are they funded?
1
2
3
4
5
6
7
(Picture from the Franklin D. Roosevelt Library, courtesy of the
National Archives and Records Administration.) Young
Oklahoma mother; age 18, penniless, stranded in Imperial Valley,
California. (Circa March 1937)
AGENDA

3. 1941-1945 WWII
Private Insurance or No Insurance Options (Self-insured)
1935 1939 1942 1948 1950
SOCIAL SECURITY ACT (SSA)– Franklin D. Roosevelt –
Funded by – Tax deduction from wages, income taxes,
excise tax on employers 1-3%.
Title II- Old Age Benefits – (Workforce 65+)
Title IV - “state dependent child” care
Title V (part 1)- Maternal and Child Health : rural areas and in
areas suffering from severe economic distress;
(part 2)- medical services to disabled children;
(part 3)- Child welfare services;
(part 4)- Vocational Rehabilitation
Title VI – Public Health Work Appropriation establishing and
maintaining adequate public-health services, Including
the training of personnel for State and local health
work;
Title X- Aid to Blind
SSA Amendments: 2 new categories of payment
beneficiaries
• Spouse & Minor children dependent on retired
worker,
• Survivor benefits in event of premature death of
covered worker.
ESI (Employer Sponsored
Insurance) The federal
government, in order to control
inflation in the overheated
wartime economy, limited
employers’ freedom to raise
wages and thus to compete on
the basis of pay for scarce
workers. It did, however, allow
employers to expand benefits for
workers, such as health
insurance, which resulted in a
rapid increase in employer-
sponsored insurance.
Last state
Mississippi passes
workers
compensation
legislation
SSA Amendments
Permanent and
Total Disability
Insurance for
injured workers.
1929-1940 Great Depression
Historical Background

4. 1965 19841977 1985 19851982 1988 1990
Historical Background
1972
1965- Medicare – Title XIX of SSA - Healthcare for disabled, end stage
renal failure, or age 65+ (Lyndon B. Johnson – War on Poverty)
Medicaid – Title XIX of SSA – Health Insurance/medical companion to
food stamps and cash assistance for welfare recipients.
http://medicaidchip.com/history
MCCA:
Required states
to pay
Medicare
premiums and
cost-sharing for
low income
Medicaid
beneficiares
below 100%
FPL
Deficit Reduction Act:
Coverage for AFDC eligible
1st-time pregnant women
and pregnant women in 2-
parent unemployed families
becomes mandatory.
Carter: Hyde Amendment
prohibits federal Medicaid
payments for medically
necessary abortions except
where life of mother
endangered.
OBRA:
mandates
coverage for all
remaining AFDC
eligible pregnant
women.
TERFA: extends
state Medicaid
provisions to
children under 18
with disabilities
requiring
institutional care
but living at home.
MCCA: Phases in
coverage for pregnant
women and infants in
families with income up
to 100% FPL
OBRA: Mandates
coverage of children
ages 6 thru 18 in
families with incomes
at or below 100% FPL
All states
except AZ
began
participating
in Medicaid
Private Insurance or No Insurance Options (Self-insured)

5. PPACA: Mandated
insurance coverage
under Obama
Administration.
DHHS assigned task of creating
report to achieve $10billion
Medicaid savings in Medicaid
during next 5 years.
Medicare, Medicaid & SCHIP
Benefits Improvement Act tightens
upper payment limits.
20051997
BBA: Signed into law in 1997, CHIP provides low-cost
health coverage to children in families that earn too
much money to qualify for Medicaid. In some states,
CHIP covers parents and pregnant women. Each state
offers CHIP coverage, and works closely with its state
Medicaid program
2003
Medicare RX Improvement &
Modernization Act: establishes Part D.
HEALTH SAVINGS ACCOUNTS:
Administered by Federal government
as a tax free account that can be used
to cover medical expenses.
2000
PRWOA: Formal linkage
between cash assistance and
Medicaid removed as AFDC
replaced by TANF.
Also prohibited extending
Medicaid to legal immigrants
for 5 years. Coverage post 5yr
up to states.
1999
Olmstead v. L.C.:
Under ADA states to
provide community
based services to
individuals for whom
institutional care is
appropriate.
Private Insurance or No Insurance Options (Self-insured)
1995 2010
Clinton vetoes
legislation to convert
Medicaid to block grant.
Historical Background
PPACA Supreme Court:
Can mandate everyone to
have coverage, but cannot
mandate states to expand
Medicaid Coverage.
1996 2009

6. Number of uninsureds 1987 to 2012
DeNavas-Walt, Proctor, Smith (2013) Income, Poverty, and Health Insurance Coverage in the United States: 2012

7. Percent of Uninsured by Income Level
Under Age 65, by State, 2012
Small Area Health Insurance Estimates (SAHIE) 2012 Highlights

8. SOLVING THE PROBLEMS
• Workers’ Comp
• ESI
• Private Insurance
• Uninsured
What do the programs do?
Who gets what? How are they funded?
How are they distributed?
• Medicare
• CHIP/SCHIP
• Medicaid
• PPACA

9. WORKER’S
COMPENSATION
Pays medical bills for
injuries or illness
directly related to
occupation
Pays permanent partial
or permanent total
disability based on
rating.
Pays a portion of
wages for time off
work due to
injury/illness on the
job. Typically 5 day
waiting period.
Funded by premiums
paid by employer.
Mandatory for all
employees.
PRIVATE
INSURANCE
prior to ACA
Individual has ability
to decide copays/
deductible amounts.
Individual or Family
insurance plans are
available to
purchase.
Benefits are typically
for medical
procedures only. No
lost wages.
Insurers could deny
based on pre-
existing conditions,
and impose lifetime
limitations on
benefits payable
(Creaming).
Funded by
premiums paid by
insured(s).
UNINSURED
Individuals and Families
absorb 100% of medical
care expenses.
Freedom of choice of
medical care providers.
Freedom of choice of
whether or not to access
medical care at all.
Can be denied medical
care if insured does not
have money to pay for
expenses.
Funded in whole by the
individual through
discretionary income…….
Or
In some cases when the
individual has no means,
by community,
bankruptcy, charity, or
other organizations.
EMPLOYER
SPONSORED
A group insurance policy
designed to insure
several individuals and
minimize risk.
Employers have open
enrollment times where
individuals can sign on
or change policies
available.
Typically do not have
choice to alter co-pays
or deductible amounts.
Insurers could still deny
or delay claims based on
pre-existing conditions.
Some policies included
mandatory use of HMO,
PPO, etc. rather than
choice of doctor.
Funded in whole or in
part by employer
through premiums.

10. • People age 65 or older,
• People under age 65 with certain disabilities, and
• People of all ages with End-Stage Renal Disease
(permanent kidney failure requiring dialysis or a kidney transplant).
MEDICARE PROGRAM – What does it do?
Most people pay a monthly
premium for Part B. Medicare
Part B (Medical Insurance) helps
cover doctors' services and
outpatient care. It also covers
some other medical services that
Part A doesn't cover, such as
some of the services of physical
and occupational therapists, and
some home health care. Part B
helps pay for these covered
services and supplies when they
are medically necessary.
Part B Medical Insurance -
Most people will pay a monthly
premium for this coverage. Starting
January 1, 2006, new Medicare
prescription drug coverage will be
available to everyone with
Medicare. Everyone with Medicare
can get this coverage that may help
lower prescription drug costs and
help protect against higher costs in
the future. Medicare Prescription
Drug Coverage is insurance.
Private companies provide the
coverage. Beneficiaries choose the
drug plan and pay a monthly
premium. Like other insurance, if a
beneficiary decides not to enroll in a
drug plan when they are first
eligible, they may pay a penalty if
they choose to join later.
Prescription Drug Coverage
Part A Hospital Insurance -
Most people don't pay a premium
for Part A because they or a
spouse already paid for it through
their payroll taxes while working.
Medicare Part A (Hospital
Insurance) helps cover inpatient
care in hospitals, including critical
access hospitals, and skilled
nursing facilities (not custodial or
long-term care). It also helps
cover hospice care and some
home health care. Beneficiaries
must meet certain conditions to
get these benefits.

11. MEDICARE PROGRAM
When an individual, their spouse,
or anyone acting on the
individual's behalf establishes a
trust using at least some of the
individual's funds, that trust can
be considered available to the
individual for purposes of
determining eligibility for
Medicaid.
Treatment of Trusts
This practice is prohibited for purposes
of establishing Medicaid eligibility.
Applies when assets are transferred,
sold, or gifted for less than they are
worth by individuals in long-term care
facilities or receiving home and
community-based waiver services, by
their spouses, or by someone else
acting on their behalf.
Transfers of Assets for Less
Than Fair Market Value:
Spousal Impoverishment
Protects the spouse still living in
the community from becoming
impoverished when the other
spouse enters a nursing facility
or other medical institution and
is expected to remain there for
at least 30 days.
State Medicaid programs must
recover from a Medicaid enrollee's
estate the cost of certain benefits paid
on behalf of the enrollee, including
nursing facility services, home and
community-based services, and
related hospital and prescription drug
services. State Medicaid programs
may recover for other Medicaid
benefits, except for Medicare cost-
sharing benefits paid on behalf of
Medicare Savings Program
beneficiaries.
Estate Recovery
Third Party Liability (TPL) refers to
third parties who have a legal
obligation to pay for part or all of the
cost of medical services provided to
a Medicaid beneficiary. Examples
are other programs such as
Medicare, or other health insurance
the individual may have that covers
at least some of the cost of the
medical service. If a third party has
such an obligation, Medicaid will
only pay for that portion.
3rd Party Liabiility
FUNDING:
Funding: Payroll taxes, Income
taxes on SS benefits, Interest
earned on trust fund investments,
Medicare Part A premiums.
http://www.medicare.gov/about-
us/how-medicare-is-
funded/medicare-funding.html

12. https://www.healthcare.gove/are-my-children-eligible-for-chip/
The benefits covered through CHIP are different in each state, but all states
provide comprehensive coverage, including:
• Routine check-ups Immunizations
• Doctor visits Prescriptions
• Dental and vision care Inpatient and outpatient hospital care
• Laboratory and X-ray services Emergency services
States may choose to provide additional CHIP benefits.
What CHIP costs
Routine "well child" doctor and dental visits are provided free of charge. But there may be copayments for
certain other services. Some states charge a monthly premium for coverage. The costs you'll have to pay are
different in each state, but you can't be asked to pay more than 5% of your family's income for the year.
CHIP
PROGRAM
To qualify a child must live in Idaho & be:
• Under the age of 19
• A U.S. citizen or legal resident
• Within family income guidelines
www.healthandwelfare.Idaho.gov/Medical/Medicaid/IdahoHealthPlanforChildren/tabid/219/Default.aspx
The Idaho Health Plan
Coverage: CHIP/Medicaid
provides low-cost or no cost
health care coverage to
eligible children.
The plan provides a full
range of health services
including regular checkups,
immunizations, prescription
drugs, lab tests, x-rays,
hospital visits and more.
Funded under Medicaid Program.

13. Administered through States
States establish and administer
their own Medicaid programs
and determine the type, amount,
duration, and scope of services
within broad federal guidelines.
States are required to cover
certain "mandatory benefits,"
and can choose to provide other
"optional benefits" through the
Medicaid program.
• Inpatient hospital services
• Outpatient hospital services
• Nursing Facility Services
• Home health services
• Physician services
• Rural health clinic services
• Transportation to medical care
• Laboratory and X-ray services
• Family planning services
• Nurse Midwife services
• Federally qualified health center
services
• Tobacco cessation counseling for
pregnant women
• Certified Pediatric and Family
Nurse Practitioner services
• Early and Periodic Screening,
Diagnostic, & Treatment Svcs
EPSDT
• Freestanding Birth Center
services (when licensed or
otherwise recognized by the
state)
Mandatory Benefits
• Prescription Drugs
• Clinic services
• Physical therapy
• Occupational therapy
• Respiratory care services
• Podiatry services
• Optometry services
• Dental Services
• Dentures
• Community First Choice
Option- 1915(k)
• Private duty nursing services
• Personal Care
• Hospice
• Case management
• Prosthetics
• Eyeglasses
• Chiropractic services
• Other practitioner services
• TB Related Services
• Other services approved by
the Secretary
Optional Benefits
MEDICAID:
What does it do?
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Medicaid-Benefits.html
FUNDING
Federal/State matching system.
Federal Gov = 50-80%
States Gov = 50-20%
States can raise their own funds
Must Be U.S. Citizen OR
Qualified Legal Resident
Typically must be parent, pregnant mother,
child, disabled or elderly
Means Tested

14. MEDICAID
Federal
Funding:
State Funding: States generate
Medicaid matching funds from
several sources, including income,
property, sales and estate taxes, and
other sources that generally make up
states’ and counties’ general funds.
But states can also raise Medicaid
matching funds by imposing fees,
assessments and other taxes on
health care providers.
http://knowledgecenter.csg.org/kc/content/provider-
taxes-revenue-source-health-care
Budget of the United States Government, FY 2010, historical
tables: table 2.1 http://www.whitehouse.gov/omb/budget/historicals

15. SIDE BY SIDE
MEDICAID
(1965)
MEDICARE
(1965)
CHIP
(1997)
HEALTH SAVINGS
2003
55 million 44 million 7 million children are enrolled in
CHIP at any given time – a figure
expected to rise to 11 million by
2013
3 million
States administer under federal
guidelines.
Federal Government The states Federal Government
Medical coverage Insurance for hospital stays (part
A) and optional coverage for
doctors’ services (part B);
Medicare advantage (hmo’s –
part C); Rx (part D)
Medical Coverage A tax-free savings account for
health insurance with a high
deductible
Low income people, including
the aged, blind, disabled and
members of families with
dependent children
The elderly and/or disabled Children in families at up to 300
percent of the poverty line
Tax payers who can afford to
establish these accounts,
generally those who are healthier
and better off
From 50-80% of each state’s
Medicaid budget comes from the
Federal government’s general tax
revenue; the state absorbs the
remainder. In 2007, total costs
for the Medicaid program
amounted to $288 billion. In
2009 and 2010, the economic
stimulus bill adds $87 billion to
Medicaid’s usual allocation.
In 2007, the Medicare program
cost $432 Billion, minus the
premiums the elderly pay, for a
net federal outlay of $379 billion.
Federal revenues for this program
come from a 1.45 percent tax that
is part of your Social Security
deduction but that, unlike Social
Security, does not have an
income ceiling.
About $8billion a year has been
allocated for CHIP, with the
federal government paying, on
average, 70% of its cost. The
revenue comes from an increase
in the tobacco tax
$600 million in 2008, amounting
to $4.6 billion between 2007 and
2011

16. Patient
Protection
and
Affordable
Care Act
2010

17. PPACA
2013
PPACA
2014

18. $3.5 trillion spending = 21% GDP
Nearly $2.8 trillion was financed by federal revenues
$680 billion was financed by borrowing
Medicare, Medicaid, and the
Children’s Health Insurance
Program (CHIP) — together
accounted for 22% of the 2013
budget, or $772 billion.
Nearly 2/3 of this amount, or
$498 billion, went to
Medicare, which provides
health coverage to approx.
54 million people who 65+ or
have disabilities.
The remainder of this category
funds Medicaid and CHIP,
which in a typical month provide
health care or long-term care to
about 70 million low-income
children, parents, elderly
people, and people with
disabilities. Both Medicaid and
CHIP require matching
payments from the states.
$166 billion = 8%
Medicaid & CHIP

19. NEGATIVE CONSEQUENCES
Those who do not have work may not have access to ESI, or may fall
within the Medicaid gap of coverage.

20. NEGATIVE CONSEQUENCES
One of the most challenging goals of the feminist movement has been protecting the rights of
women over their own bodies. Reproductive rights, which runs the gamut from the right to
abstinence, birth control, abortion, and the right to carry a pregnancy to term, must still be
protected in the courts, on the streets, and in the halls of Congress.
http://civilliberty.about.com/od/gendersexuality/tp/Reproductive-Rights-History-United-States-
Timeline.htm
GENDER DISCREPANCY - REPRODUCTIVE RIGHTS
McFarlane, D., 2006. Reproductive Health Policies in President Bush’s Second Term: Old battles and new fronts in the US and internationally.

21. Comstock Law bans interstate
mailing of “obscene materials”
specifically material on
abortion or birth control.
National Birth
Control League
founded
“Right to
security in their
persons…”
4th Amendment
The Married Lady’s Companion: In
this book, abortion was defined as
any natural termination of fetus
prior to 6 months of gestation.
After 6 months was called
premature labor. Addressed
medical needs during menses &
pregnancy as well as authority over
children. Considered “cutting
edge” for the times and led to
further censorship in society due to
graphic nature.
Connecticut
1st state to
ban
abortion
Griswold v. Connecticut: US
Supreme Court strikes ban
on contraception based on
right to privacy implied
under 14th Amendment due
Process
14th Amendment: No deprivation of life, liberty,
and property without due process interpreted by
Supreme court to imply right to privacy.
Birth Control Pill
gains FDA approval
in Puerto Rico
1790 1808 1821 1873 1916
Historical Background
1965
http://civilliberty.about.com/od/gendersexuality/tp/Reproductive-Rights-History-United-States-Timeline.htm
1956

22. REPRODUCTION - 1808
“…But under present circumstances, it is your interest to adapt yourself to your
husband, whatever may be his peculiarities. Again, nature has made man the
stronger, the consent of mankind has given him superiority over his wife, his
inclination is, to claim his natural and acquired rights. He of course expects from you
a degree of condescension, and he feels himself the more confident of the propriety
of his claim, when he is informed, that St. Paul adds his authority to its support.
Wives submit yourselves unto your husbands, as unto the Lord, for the husband is
the head of his wife.” (Jennings, S., 1808. Emphasis Added.)
“When any article of property is to be bought or sold, take him
aside, teach him the price to be given or received, point out the
kind of payment, the time to be paid, & let the whole business be
properly adjusted, and then let the poor fellow go forward and
seem to act like a man.”

23. Idaho: Federal
Judge strikes down
law that would ban
abortions after
20wks.
1973 1989 1996 2001 2004
George Bush
institutes global gag
rule that eliminates
funds for women’s
health services that
provide information
on abortion. (later
overturned by
Obama)
March for
Women’s Lives:
targets Bush
abortion
regulations
Roe v. Wade:
Supreme Ct.
extends ruling of
privacy in
Griswold to
include privacy
regarding
abortion.
Webster v.
Reproductive
Health
Services:
Supreme Court
weakens Roe
allowing some
restrictions to
abortion.
Historical Background
Bill Clinton states
“abortion should be
legal, safe, and rare….”
1981
Oregon’s last
forced
sterilization of
promiscuous
women, gays, or
people who
masturbated.
2013 2014
Idaho: Doctors
performing
abortions must be
certified/licensed.
March: Louisiana passes abortion restriction. Physician must have
admitting privileges to hospital within 30 miles.
http://thinkprogress.org/health/2013/02/07/1554731/transvagina
l-probes-under-radar/
April: Colorado
Senate passes
proactive measure
that ensures
government CANNOT
interfere with
woman’s reproductive
health.
http://www.naral.org/
April: Missouri lawmakers introduce over 30 abortion restriction laws and compare
to purchasing a car. http://www.huffingtonpost.com/2014/04/09/abortion-buying-
car-chuck-gatschenberger_n_5119730.html
April: Arizona - Planned Parenthood
appeals after federal judge refused to
temporarily block nation’s most
stringent restriction on use of abortion
drugs after 7th week of pregnancy.
March: Hobby Lobby case before U.S. Supreme Court on religious merits that they
should not have to pay for contraception, Planned Parenthood defunded in Kansas
under Title X, & Texas 5th circuit Court of Appeals upholds 30 mile rule.
http://www.wnd.com/2014/03/worst-week-for-abortion-in-50-years/

24. Abortion Restrictions by State
http://search.yahoo.com/search?fr=mcafee&type=A111US0&p=vessel+documentary

25. US reported abortions by year
http://www.abort73.com/abortion_facts/us_abortion_statistics/
ABORTION AND PUBLIC FUNDS
•The U.S. Congress has barred the use of federal Medicaid funds to pay for
abortions, except when the woman's life would be endangered by a full-
term pregnancy or in cases of rape or incest (AGI).
•17 states (AK, AZ, CA, CT, HI, IL, MA, MD, MN, MT, NJ, NM, NY, OR, VT, WA
and WV) use public funds to pay for abortions for some poor women.
About 14% of all abortions in the United States are paid for with public
funds—virtually all from the state (AGI).
ABORTION AND CONTRACEPTION
•Induced abortions usually result from unintended pregnancies, which often occur
despite the use of contraception (CDC).
•51% of women having abortions used a contraceptive method during the month they
became pregnant. (AGI).
•8% of women having abortions have never used a method of birth control (AGI).
•9 in 10 women at risk of unintended pregnancy are using a contraceptive method
(AGI).
•Oral contraceptives, the most widely used reversible method of contraception, carry
failure rates of 6 to 8% in actual practice (NAF).
•Condom use confers protection against STIs, but it does not provide top-tier
protection from pregnancy because of breakage, slippage, inconsistent use, and
low continuation rates (NAF).
0.0-1.24

26. http://www.mccl.org/us-abortion-stats.html
Why do women have abortions?
•74% say having a baby would interfere with work, school, or other responsibilities.
•73% say they cannot afford to have a child.
•48% say they do not want to be a single parent, or have relationship problems with
husband or partner.
•Less than 2% say they became pregnant as a result of rape or incest.
Source: The Alan Guttmacher Institute, Perspective on Sexual &
Reproductive Health, Sept. 2005
US reported abortions by year
Population Reference Bureau (2011), Abortion Facts and Figures.

27. Opposing Arguments – “It’s a moral issue!”
Planned Parenthood uses your tax dollars to do its dirty work.
$4,866,000 in state and federal taxpayer dollars went to PPMNS in 2009 in the form of government
grants, including those for “family planning.” $31,998,000 was PPMNS’s total revenue in 2009 from all
sources, including patient fees and grants. Therefore, more than 15 percent of PPMNS’s total 2009
revenue was provided by taxpayer dollars. PPMNS ended 2009 with $27.9 million in total assets—
nearly six times the amount it received in taxpayer funds. In the 1995 Doe v. Gomez decision, the
Minnesota Supreme Court declared that women receiving medical assistance were entitled to
abortions at taxpayer expense. PPMNS has received more than $1.5 million to perform over 6,100
taxpayer funded abortions. http://www.mccl.org/Planned-Parenthood-means-abortions.html
Easy access to free and confidential contraceptives makes yielding to the temptations of sex much
easier, particularly for a spontaneous teen. Once sexually active, a teenager is “hooked” by Planned
Parenthood as another client for its “family planning” services. However, we all know that no
contraceptive is 100 percent reliable.
Every method has a failure rate (except for abstinence); therefore, unintended pregnancies will result.
Contraceptive failures guarantee clients for Planned Parenthood’s more lucrative abortion business.
How will they feel when they marry and discover they are sterile or cannot carry a baby to full term because
of complications of that one abortion? It is possible that the only child they will ever conceive died in
that abortion. When contraceptives fail and result in a pregnancy, what does that say about their ability
to prevent HIV/AIDS and other sexually transmitted diseases? If you are a teen who has been taken in
by Planned Parenthood's speakers, ask yourself: who loves me more, my parents or Planned
Parenthood?

28. 4.21-5.13http://www.youtube.com/watch_popup?v=XNUc8nuo7HI
Opposing Arguments – “It’s a moral issue!”
5.29-7.45Dennis Prager – America is the last great hope
http://www.youtube.com/watch?v=Jfb9f7yFYgw&feature=player_embedded
.50-2.27Rush Limbaugh on Access to Birth Control
http://www.youtube.com/watch?v=R287tpce8Ss
4.05-5.00Howard Stern on Access to Birth Control and Abortion
BY IDAHO SENATOR STEVEN THAYN: In a bull fight, the matador faces an angry bull. The goal of the bullfighter
is to subdue the bull by causing extreme exhaustion. The bullfighter creates this fatigue, toward the end of the fight,
by waving a red cape at the bull. The bull wants to gore the bullfighter; but is distracted by a meaningless cape. In the
end, the bull is defeated because it chases the wrong target.
In like manner, the debate over ObamaCare and a state or federal health exchange is a meaningless debate. The
puppet masters that control the debate wave a distraction at the American people and they charge into this empty
debate. The end result will be exhaustion and defeat; unless the real cause of high medical costs is clearly defined.

29. Opposing Arguments – “We just can’t keep
spending, we need to decrease the deficit.”

30. What are Other Countries Doing About Healthcare?
Description Canada
(Medicare)
US
(PPACA)
Sweden
(Swedish Nat’l HC)
% of GDP for Health Care 10.9 17.9 9.6
World Ranking (of 190 WHO) 30 37 23
Covered Contraception X X X
Covered Abortion Yes No Prior to 18 weeks
Preventative Care Yes Yes Yes
Dental Care No Low Income Children &
some disabled
To Age 20
Maternity Care Yes Partial Yes
Maternity Leave 50 wks @ 55% monthly
salary capped at $501/wk
6 wks unpaid 13 months paid @ 77.6% monthly
salary + 90 days @ $25/day
Prescription Drugs Partial Partial Partial
Private Insurance Options X X X
Tied to Job No In some instances No
“Not only are we not No. 1... we are among the worst of the worst.” In the words of the column's headline
writer, the United States is an “Empire at the End of Decadence.”
Blow CM. Empire at the end of decadence: it's time for us to stop lying to ourselves about this country.
New York Times. February 18, 2011. http://www.nytimes.com/2011/02/19/opinion/19blow.html

31. Affordable
and Adequate
Coverage?
WHAT’S IDAHO DOING?
How Does the Exchange Fit Into Federal Health Reform?
Individual
applies for
coverage
through
Exchange
Is Employer
Coverage
Available?
YES
No Premium Tax
Credit Available
Individual will qualify for
Premium Tax Credit
through Exchange if
Income up to 400% FPL
Individual will qualify for
PTC through Exchange if
Income up to 400% FPL
Employer may face
Penalty
NO
NO
YES
The Idaho Exchange went live in 2013 after
the legislative session debated using the
Federal Exchange or creating a State
Exchange.

32. $7,164
Groceries
$10,820
Rent
$3,476
Utilities
$2,748
Gasoline
$24,208
WHAT’S IDAHO DOING?
FPL ANNUAL GUIDELINES 2014
FAMILY PERCENT OF POVERTY GUIDELINE
SIZE 100% 120% 133% 135% 150% 175% 185% 200% 250%
1 11,670.00 14,004.00 15,521.10 15,754.50 17,505.00 20,422.50 21,589.50 23,340.00 29,175.00
2 15,730.00 18,876.00 20,920.90 21,235.50 23,595.00 27,527.50 29,100.50 31,460.00 39,325.00
3 19,790.00 23,748.00 26,320.70 26,716.50 29,685.00 34,632.50 36,611.50 39,580.00 49,475.00
4 23,850.00 28,620.00 31,720.50 32,197.50 35,775.00 41,737.50 44,122.50 47,700.00 59,625.00
5 27,910.00 33,492.00 37,120.30 37,678.50 41,865.00 48,842.50 51,633.50 55,820.00 69,775.00
* U.S. Bureau of Labor Statistics - averages are based on 2.6 person households
What about Medicaid Expansion?
Many states have expanded coverage, particularly for children, above the federal minimums. For many eligibility groups, income is
calculated in relation to a percentage of the Federal Poverty Level (FPL). The Federal Poverty Level is updated annually.
For other groups, income standards are based on income or other non-financial criteria standards for other programs, such as the
Supplemental Security Income (SSI) program. www.Medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html

33. www.healthandwelfare.Idaho.gov/Medical/Medicaid/MedicaidParticipants/tabid/220/Default.aspx
Idaho Medicaid's Benefit Plans
Medicaid now does more to improve your health, find new health problems early, and manage current health problems. If
you are eligible for Medicaid, you will get benefits based on your health needs. For more information about each plan, click
on the plan names below.
• The Medicaid Basic Plan is for healthy low-income children and adults with eligible dependent children. This
plan provides complete health, prevention, and wellness benefits for children and adults who don't have special health
needs. Most Medicaid participants will be enrolled in this benefit plan. (As implemented July 1, 2006)
• The Medicaid Enhanced Plan is for participants with disabilities or special health needs. This plan includes all
benefits in the Basic Plan, plus additional benefits. (As implemented July 1, 2006)
• The Medicare-Medicaid Coordinated Plan is for participants who are eligible and enrolled for both Medicare
and Medicaid. (As implemented July 1, 2006)
• If you are enrolled in the Medicaid Basic Plan and your health changes, you may need to get an assessment to find out
whether you should be in the Medicaid Enhanced Plan.
WHAT’S IDAHO DOING?

34. IDAHO MEDICAIDImplemented July 1, 2006
6.4%
34.2%
8.9%
10.3%
9.9%
16.3%
10.2%
20.6%
64.5%
18.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Enrollees Expenditures**
SFY 2012 Idaho Medicaid Enrollment and Expenditure
Comparison*
Children - Basic Plan Children - Enhanced Plan Adults - Coordinated Plan
Adults - Basic Plan Adults - Enhanced Plan
* Source: Idaho Department of Health and Welfare,
"Facts, Figures and Trends: 2012-2013", Page 17.
** Expenditures are total State and Federal Funds. State Funds represent 30.1% for SFY 2012 (Source: Ibid, Page 15)
As of 2014 legislative session, Idaho is not expanding Medicaid to cover
individuals falling in the gap.

35. Woodwork
Available to 400%FPL
Available to 400%FPL
Available to 400%FPL
Available to 400%FPL
Available to 400%FPL
Available to 400%FPL
Available to 400%FPL
Available to 400%FPL
185%
185%
Idaho Dept. of Health and Welfare
138%
100%
138%
80%
80%
230%
Children
Under 6
Adults
w/children
Children
6-18
Pregnant
Women
Adults
Over 65
People
with
Disability
People
w/ Severe
Disability
Adults
w/o children
Medicaid & Insurance Exchange Without Optional Enrollment
PERCENT OF FEDERAL POVERTY LEVEL (FPL)
50% 100%0 150% 300%200% 250%
Tax Credit Eligibility Minimum
Medicaid CHIP
Mandatory Optional
HIX APTC Medicare
KEY
ELIGIBILITY
CATEGORY
Medicaid
replaces CHIP
Other Coverage
138%
Medicaid replaces CHIP
~26%
97,066-111,525
newly eligible
Idahoans in Gap

36. IDAHO MEDICAIDImplemented July 1, 2006
Health care
options for
Idaho’s low
income
workers
MedicaidCounty
Indigent
Program
State
Catastrophic
Fund
Emergency
Departments
Charitable
Orgs.
How does someone access medical care if they’re
in the gap?
Doesn’t sound effective. How does it work?

37. IDAHO MEDICAIDImplemented July 1, 2006
High cost
Funded by Idaho Sales and Income tax.

38. Implemented July 1, 2006
High cost
Funded by county property tax.
Poorer counties are not able to
allocate as many services.

39. Over $1 billion
in tax dollars from
2014 - 2024
Eliminate Waste

40. THANK YOU!
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