Meeting Agenda

Hosted by the City of BoiseAda County

Date: August 27, 2018
11:00 am – 1:00 pm

Location:
Boise Fire Training Center
12142 Joplin Rd.
Boise, ID

11:00 am – 11:05 am
  Welcome and Introductions
Mayor Dave Bieter
11:05 am – 12:00 pm
Open Discussion
12:00 pm – 12:15 pm
Update – Treasure Valley Opioid Program
 Mayor Dave Bieter
12:15 pm – 12:40 pm
Medicaid Expansion Ballot Initiative
Jefferson Kemper
12:40 pm – 12:45 pm
Director’s Report
 – Minutes and Financial Statement
 – SAUSA Program Savings – Treasure Valley & Eastern Idaho
Bill Larsen
12:45 pm – 1:00 pm
Tour of Boise Fire Training Center

 

Medicaid Expansion Ballot Initiative Presentation

Treasure Valley Partnership

Meeting Minutes – August 29, 2018

Attendees
Alicia Almazan
Chad Bell
Dave Bieter
Tom Dale
Tammy de Weerd
John Evans
Debbie Kling
Nathan Leigh
Joe Stear
Jim Tibbs
Guests and Staff
Lauren Necochea – Director, Idaho Voices for Children
Bill Larsen – TVP

Open Discussion

Mayor Dave Bieter welcomed everyone to the new Boise Fire Training Center. He hoped people would take the time to do the tour of the facility at the end of the meeting. He indicated they are really pleased with this center. Dave said, it is important to be able to train our folks as well as we can. We did have substandard training facilities that restricted the kinds of fluids we, could practice with and the new facility solves that problem.

SAUSA Program

John said he attended a meeting with U.S. Attorney Bart Davis and Rafael Gonzales. The issue was the current SAUSA is getting hired by the U.S. Attorney’s office. The U.S. Attorney’s office has recently been authorized an expansion of staff and they have been going through that process. Through the interviews to fill the expansion, they have found someone whom they would like to replace the SAUSA with. This person has been number # 2 in the last several hiring cycles. Because of the labor market we are dealing with they would like to strike while this person was available.

They have talked with Bryan Taylor in this regard and wanted to meet to get our permission to have an abbreviated process for the next SAUSA hire. He added that he had met briefly with a couple other Partnership members on this topic in the previous week. John asked permission to let the U.S. Attorney’s office utilize the abbreviated process for this hire.

There was agreement among the members present to tell Bart and Rafael to pursue hiring through this process.

John added that the person they have in mind, they have already vetted on a couple occasions.

John said, it wasn’t that long ago that when we put a posting out for a SAUSA, we would have lots of applicants. Rafael indicated that over the last several hiring cycles for the U.S. Attorney’s office, they have received a smaller number of applications and they have had the same people applying. Evidently the person they want to hire for the SAUSA was a very close second in one of their previous hires.

Opioids

Dave said the previous discussion was a good segue to an idea he would like to run by the members. He wanted to see if the SAUSA could be used for opioid help. Tammy said she thought that is a great idea. Eastern Idaho set their own priorities on what they wanted to have the SAUSA pursue, and she thinks this will work just fine.

Tom asked what kinds of crimes they would be charging on a federal level. There was a discussion and agreed it would be called trafficking. Dave indicated he would follow up on this question with Jodi McCroski to get some clarification.

Dave wanted to know if people were pleased with how we have begun addressing Opioids. He has been pleased with the number of people that showed up to the planning meeting and the number of people working on strategy committees. He said he would like to have Jodi come to a future meeting to give us an update on how the Opioid committee work is progressing. He stressed that he feels it is important to have someone that this is their mission. That they wake up every day working on this effort, and thinks Jodi is doing a good job.

Dave said we had the plan come out and we held the press conference. The question for all of us was, how will you measure success. He felt that success would be achieved if there were fewer fatalities from opioids than there were before.

Jim asked if we had Dotti Owens come in and talk about this issue. Tammy said that Dotti spoke at the initial meeting of the TV Opioid Committee. The biggest challenge the Coroner’s Office has is whether the hospital cites an overdose as a possible reason for death and if they draw blood. Hospitals haven’t been necessarily good at the blood sampling. Tammy said that Dotti she is working on her end to determine legislative fixes.

Tom said these issues were also brought up in Canyon County as well.

Dave said he read a piece about an academic study. Evidently, in the study they told a doctor that one of his patients had died from an overdose of painkillers that the doctor had originally prescribed in the early going. What they found out was, the doctors reduced the number of opioids they were prescribing to their next patients.

John added that part of what we heard for the reason for the overprescribing, was to deal with a longer supply because it is a pain in the neck to deal with these prescriptions over and over again.

Debbie indicated that she hadn’t seen the results of the TV Opioid meeting. Bill indicated he would send a copy of those out to the members.

Debbie said she recently sat in a meeting where the opioid topic was being discussed. During the meeting she got to thinking that the effort seems fragmented. There is lots of good work being done and it helps to understand how important this group is. Local communities working together is what is going to make the biggest impact.

Tammy said we found there is a lot going on, but nobody is informing local elected officials. We know about the problem, but we are not hearing about all the good work that is being done.

John said we do have a pharmaceutical registry that is voluntary. He thought we were going to see some interest in making that mandatory. There was a discussion about maybe inviting someone to come to us about this and Bill said he would set it up.

Tom asked if the solution to the problem is; more enforcement or more education. Is it increasing enforcement of “traffickers” or is it cutting down on the over prescribing of opioids by doctors. His understanding is; there are not necessarily people coming in from out of State and selling Oxycodone’s on the street, but it is people who have had 90 days supply prescribed by their doctor.

Tom asked, do we want to focus on federal prosecution or do we want to focus on educating the public or to stop overprescribing.

Debbie added that heroin is cheaper and this last year Nampa had a large heroin bust. But her understanding is the addiction to opioids is driving people to heroin use.

John said that on the education side, the general public’s attitude is that if a doctor prescribes it to them then it is safe, and the presumption is that taking this prescription is not going to turn them into a drug addict. As an example, they had an employee that had an accident and was prescribed opioids. However, she refused to take it because of the fear of getting hooked.

Dave said the supply part of this is a big piece. The law enforcement piece for some other drug may not be that effective, can be effective in the evolution of this opioid problem in our valley. It could reduce the supply enough so that those that do get hooked won’t be able to find a cheap substitute.

Jim said that Dotti Owens gave a profile of the user. What she has seen regarding opioids that are strictly prescription drugs, the deaths are occurring in males 40-50 years old that are professional people. They have either had a recent surgery or injury that got them hooked. Heroin and Fentanol is a whole other issue. These are illegal drugs that are coming in.

Alicia felt that education is the most important issue. It is too big to try to control all the other stuff. She takes prescription medication and has a one-month supply. She doesn’t take all of them, so the medication is there. Her kids have access to them. But if there were adequate education, they could make that choice. We need to make sure there is enough education that it is reaching our children and they need to make sure this education gets repeated.

Tom said in a related issue, they have an upcoming meeting in Canyon County discussing the lawsuit that is going around. It is not a class-action lawsuit, but there is a case back east where a county brought a suit against pharmaceutical companies. These companies were training doctors for years that opioids were not addictive. The lawsuit focuses on the abuse of their training programs. This landmark case has potential of hitting hard on these companies.

Tammy said having Jodi and Dotti here to talk about the strategies they have put together is a good idea. There are different action items associated with the TV Opioid Strategic Plan that this group would be very interested in playing a role in. The other person she thinks would be good is Chief Bones and he could talk about the law enforcement diversion program they are instituting.

Jim said whenever we are talking about a drug problem, you need a strategy around enforcement, prevention/education and treatment. Nobody likes to talk about the treatment component because it is expensive, but it should be part of the strategy.

Tammy said this is a good point. There was a gal at the TV Opioid Summit that had an addiction. Her takeaway was the understanding that coming off of opioids has to be the most painful of all the different drugs. Hearing more about here journey was a real eye opener. The treatment side is huge. Having a better understanding of those that find themselves down this road is really critical.

Justice Reinvestment Initiative

Tammy asked that we bring Jan Bennetts in and talk about the Justice Reinvestment Act. If you are tracking the violent crimes in your cities, you are noticing that oftentimes these are criminals that have been let out early. They might have been in prison because of a drug charge or nonviolent crime and are getting out and committing violent crimes.

Jan has a stack of cases of examples of how this has had a real impact on all our communities. They are looking at bringing something to the legislature this year. Bill said he would talk with her.

Legislative Topics

Tom said everybody has been working on their budgets for this next year. It seems like most everything we do comes out of property tax. There are at least three school bond elections in just Canyon County. He finds no rational why school districts are restricted from impact fees. Counties, cities, highway districts and others can use them. In his estimation one of the biggest reasons we need to build more schools is because of growth. Yet they are not allowed to do this.

This is a need for legislation and may be a doable thing. At least they would have this tool and five years from now when they need to build more schools, they would have money to build them. He would like to get the partnership involved with this. Joe agreed and said he has been all over the legislature asking the question why school districts were left out of this capability.

Tammy said the legislature was lobbied heavily from the builder and contractor associations and from the realtor associations. She believes the realtors might support this issue now from a property tax and quality of life standpoint, as they have been stepping up and supporting bonds. These two lobby groups feel that the extra cost it would add to homes would be too high.

Dave said they finally have their impact fees up to 100% of the capital improvements and it took them forever. Debbie said they will be looking at theirs this fall as they have been way off.

Tammy said that the West Ada School District has been looking at a different approach. Maybe we could someone from their come in and talk about what they are proposing.

Grocery Tax

Debbie has heard this is coming back again. She doesn’t know where the cities are on this issue. If this goes away, the legislature says they will make cities whole. The reality of that leaves a question of the length of this.

John said the big issue they are looking at AIC is the definition of “whole”. What they have done in the past, for example the personal property tax, is set a specific number. If that number is not indexed, then it doesn’t keep you whole because of the inflationary component.

He encouraged her to express her concerns to Jess Harrison with AIC so we can have a portfolio built on this issue.

Medicaid Expansion Ballot Initiative

Dave introduced Lauren Necochea the Director of the Idaho Voices for Children. She was here to talk about Idahoans for Healthcare which is a formal ballot initiative for Medicaid expansion (Prop 2).

As you know, there is a glitch in our health care system. This is the gap where people make too much to qualify for Medicaid and make too little to obtain a tax credit in the health insurance exchange. There are approximately 62,000 Idahoans that fit into this category. Broadly, the people in this coverage gap are working moms, veterans, farmers, ranch hands and those who are nearing retirement.

The legislature the last several years has had trouble coming up with a solution for this problem. There have been many efforts which included last year’s federal waiver proposal.

People who have been working and hoping for a legislative solution, began to lose faith in the legislature’s ability to address this problem. Late last year a group of volunteers started to get energized about putting together a ballot initiative. They started getting signatures and have collected near 75,000 signatures, way more than is required for an initiative like this. In the end, over 1,000 volunteers worked on this effort.

The ballot language for Proposition 2 reads, that Idaho Code be amended so the state shall expand Medicaid eligibility to adults under the age of 65 with incomes below 138% of the federal poverty line.

Polling shows that Idaho voters by and large support the ballot initiative with 60% of likely voters in support. The polling also shows that the support crosses political lines with Republican and Democrat voters in support of the initiative.

Tammy asked what the percentage of yes votes needed to pass the initiative will be. Lauren said that it is a simple majority that is needed – 50% + 1. She added that, of course you want to win big so the legislature feels like they have a strong mandate.

If it passes, Proposition 2 will have an effect of bringing nearly $400 million of federal taxpayer money back to Idaho. Also, there will be money saved as a result of cost reductions in state and county programs like the indigent fund.

Lauren said there is also going to be an impact for local law enforcement. 42% of the Catastrophic/Indigent program claimants received mental health treatment. We also know that there are more people with mental illness in county jails than are being treated by psychiatric hospitals. Closing the coverage gap will give Idahoans the treatment they need and will hopefully relieve this revolving door in county jails.

Since 2016, the number of drug-induced deaths in Idaho caused by opioids has increased by 69%. In States that have expanded Medicaid, the uninsured rate for opiate-related hospitalization has plummeted by 79%. In other States with Medicaid expansion they experienced a reduction in crime rates and increase in the number of people receiving treatment for substance abuse.

Another way to look at what Medicaid expansion will do is to look at the number of people you can serve with the current program compared to the expansion. Under the current system, between 4-5,000 indigent cases are processed each year. It is projected that there could be an increase of 91,000 Idahoans will have health care coverage.

Endorser’s of the ballot initiative represent a broad cross section of society. The business community in the form of Chambers of Commerce and the Idaho Association of Commerce and Industry have endorsed the Proposition. In addition, several legislators have endorsed the proposition, including Representative’s Perry, Wood and Malek as well Senator’s Keough and Martin.

Lauren encouraged the TVP members to support the Proposition 2 in several ways. We can agree to be a formal endorser, or you can voice your support through op-eds and letters to colleagues. And of course, you can vote Yes on November 6.

When it comes to op-eds, they would be there to help you craft something. Her contact information is 208-947-4257.

Jim mentioned that in Ada County, when the Affordable Care Act was instituted, they saw about a 50% drop in their indigent hearings. He asked, of all the Federal money that is coming in, how long does that last? Lauren stated that the Federal match is at 90%. Jim said he was concerned with how it is structured. He has heard legislators say if we expand Medicaid, the indigent fund will go away. This is not necessarily the case as the indigent cases include more than medical reasons.

They see a lot of cases that include the homeless population. What is the intent to help this population? Lauren said all those people will be eligible.

Tom said from his perspective, this will dramatically reduce the burden on property tax payers for multi-million hospital bills.

Dave moved to approve the minutes and financial report. Motion carried.

Tour of Boise Fire Training Center

Dave introduced the Boise City Fire Chief, Dennis Doan. Chief Doan said they have a large amount of property, about 17 acres. They hire between 10-15 firefighters a year. It takes about 6 months of training before they can hit the line.

They have a Class A Burn building. Class A is wood. They also have a Class B burn building which means it is for gas. The class B Building has about 4 props that they use. For example, thet have a prop for kitchen and bedroom fires.

Tammy asked if they are still working with CWI on the creation of something like a “Post”. Chief Doan said, Idaho is one of the only states that doesn’t have a State “Post”. He has a goal to turn this into a State Fire Academy to work with colleges and with the State to get certifications. This would reduce the cost to each of us for our training needs.

The answer is yes, he is working with CWI, but believes we still have a long way to go to get there.

Meeting adjourned and Tour began.