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Melissa Davlin: We're at the end of March, and lawmakers still have some work to do, including rewriting some budgets they voted down.

But there are other topics that apparently aren't on the table, like tweaking Idaho's abortion ban to address physician concerns.

I'm Melissa Davlin.

Idaho Reports starts now.

Hello and welcome to Idaho Reports.

This week, Kevin Richert of Idaho Education News and James Dawson of Boise State Public Radio bring you the latest from the state house, including budgets going down and education bills in limbo.

But first, this week, the Senate and House Health and welfare committees were scheduled to hear from medical professionals on the effects of Idaho's abortion ban on physician recruitment and patient care.

Lawmakers ultimately canceled that hearing, but the problems still exist.

On Friday, Dr. Jim Souza, chief medical officer of St Luke's, OB-GYN Dr. Megan Kasper, and the Idaho Medical Association's CEO Susie Keller, joined me on set to talk about their concerns.

Thanks so much for joining us today.

Susie, statewide, what's the situation on the ground?

Statewide, what's the situation on the ground?

Well, in February of this year, the Idaho Physician Susie Keller: Well, in February of this year, the Idaho Physician Wellness Action Collaborative had gathered some data that was published showing that that was published showing that between August of 2022, in November of 2023, between August of 2022 and November of 2023, we've lost about 50 OB-GYNs in the state.

we've lost about 50 OB-GYNs in this state.

That's about 22% of our OB-GYN workforce.

That's about 22% of our OB-GYN workforce.

So that's had quite an impact, as you might imagine.

So that's had quite an impact, as you might imagine.

We know from her in 2018, We know from HERSA in 2018, they estimated that we should have about they estimated that we should have about 250 OB-GYNs for our population at that time.

for our population at that time.

And looking forward to 2028, they think we need about 275. they think we need about 275.

So we're behind the eight ball quite a bit.

So we're behind the eight ball quite a bit.

So we've been losing these physicians too, at a time Davlin: So we've been losing these physicians too, at a time when our population has been growing.

Keller: Absolutely.

Absolutely.

And right now we have about 210 practicing OB-GYNs and about 975,000 women in the state of Idaho.

and about 975,000 women in the state of Idaho.

That puts our ratio at about 2.2 OB-GYNs per 10,000 women.

That puts our ratio at about 2.2 OB-GYNs per 10,000 women.

Nationally, the ratio has been about 14 Nationally the ratio has been about 14 OB-GYNs per 10,000 women.

Davlin: Dr. Souza, what is recruitment like?

What's it like trying to convince people to come here and work?

and work?

It's become much more difficult.

Dr. Jim Souza: It's become much more difficult.

Positions that we used to fill in a matter of weeks now are open for months or they they just go unfilled.

Or they they just go unfilled.

And worse than that is And worse than that is we keep digging the hole deeper, so to speak.

we keep digging the hole deeper, so to speak.

Probably the the group of Probably the group of women's health care providers that have been hit the hardest women's health care providers that have been hit the hardest by the fear and lack of clarity in the law by the fear and lack of clarity in the law have been the maternal fetal medicine specialists.

You just heard from Suzie about the OB-GYNs.

the OB-GYNs.

These are the physicians with extra training who manage high risk pregnancy and pregnancies with fetal complications and we lost fetal complications.

And we lost 5 of 9 in the past year.

Is that St Luke's specifically or statewide?

Davlin: Is that St Luke's specifically or statewide?

Souza: That's statewide.

Davlin: So more than half?

Souza: Yes.

Davlin: Have, these physicians said specifically whether they're not applying for these jobs or they're leaving it specifically because of the laws?

Souza: Yes.

Well, I was actually just reviewing a was actually just reviewing physician engagement, raw comments physician engagement raw comments from our survey last year, and, you know, it's de-identified.

you know, it's de-identified, so I can't tell who's writing the comments, but, you know, I can tell you that the folks, you know, I can tell you that the folks, the physicians leaving are an even more broad group than OB-GYNs and maternal fetal medicine specialist.

OB-GYNs and maternal fetal medicine specialist.

So it also has tentacles that have impacted the broader physician workforce.

impacted the broader physician workforce.

Davlin: What other areas of medicine are affected?

Well, I mean, specific to to this, Souza: Well, I mean, specific to this.

I you know, as the maternal fetal medicine I, you know, as the maternal fetal medicine docs are impacted, docs are impacted, the OB-GYNs and family physicians and even nurse midwives who practice in rural areas you know, began asking questions about whether it's safe to do what they do.

The presence of a maternal fetal medicine The presence of a maternal fetal medicine bench is why you can manage a high risk pregnancy, you know, from 100 miles away.

And, you know, I would also remind And, you know, I would also remind our viewers that OB-GYNs don't just deliver babies all the viewers that OB-GYNs don't just deliver babies.

because they also provide They also provide the health care for the reproductive organs.

And, you know, the population growth that we're expecting, we are expecting greater growth in the over 60 population.

we are expecting greater growth in the over 60 population.

Those women are going to need gynecologic care.

It's not just women of childbearing age.

Davlin: It's not just women of childbearing age.

That's right.

Dr. Kasper, you're in the thick of it as a practicing OB-GYN in KENYON County.

as a practicing OB-GYN in Canyon County.

how has the situation How has the situation changed for you over the past couple of years?

So how we take care of Dr. Megan Kasper: So, how we take care of patients is, has remained unchanged.

But the the things we have to think about But the things we have to think about and navigate through have increased.

And and that's been an interesting, And that's been an interesting, interesting experience in a field of medicine that is already complex when you're taking care of pregnant women when you're taking care of pregnant women and you have two patients, the mother and the fetus, fetus, there's it's always more complex than just a single patient.

And there are always things.

And there are always things.

It's a constant conversation.

This is the information that we have at this point in time.

This is the information that we have at this point in time.

We're going to do this.

We're going to see what happens.

Things are going to change.

And now there's this extra layer of, okay, What am I allowed to do?

what am I allowed to do?

What am I not allowed to do?

Am I going to get maybe I'm not worried about getting myself in trouble, but am I going to get someone else in trouble?

Am I documenting this adequately?

There's more layers for the some of the especially early pregnancy complications.

And then the other piece that has been a big impact is the availability of maternal fetal medicine.

You know, there is we're very careful now You know, there is we're very careful now about who we refer to maternal fetal medicine.

And sometimes it's a call to say, hey, this is what I have, do you guys need to see this patient, or do you want to just, see this, this patient, or do you want to just, you know, give me a little bit you know, give me a little bit of guidance over the phone?

Because I need them to when I have a mom with a baby when I have a mom with a baby that's got a lot of problems.

that's got a lot of problems, you know, we do an anatomy ultrasound and we find some problems that that baby has or a mom with a really complicated pregnancy.

I need to know that they're going to have space on their schedule to see those patients.

And so it's instead of just sending a instead of just sending a referral off, it's now a multistep process for us.

So that that increases your workload.

Davlin: So that 2increases your workload.

Ultimately, how does that affect the patients?

So the effect Kasper: So the effect directly to the patients, I think we have directly to the patients, I think we have so far so far been able to mitigate that.

been able to mitigate that.

You know, it's us as providers You know, it's us as providers that end up being that safety net.

You know, we work more hours, we see more patients, and we work very hard to do that safely.

and we work very hard to do that safely.

I work in Canyon County.

I work in Canyon County.

I'm based in Nampa.

And in our health district, which includes Canyon County, a wiki, Payette Adams, Washington and Gem counties.

Owyhee, Payette, Adams, Washington and Gem counties.

That population for the the the population of reproductive That population for the population of reproductive age women that we should have, that we have in that area, we should have somewhere between 30 and 40 We should have somewhere between 30 and 40 OB-GYNs in that area OB-GYNs in that area.

as of As of 5 p.m. tonight with Saltzer closing, which is one more in a list of a lot of closures we've had in the last of a lot of closures we've had in the last year and a half, two years, year and a half, two years, we will have 11 FTEs of OB-GYNs in that area, less than less than one third of what we should have, less than one third of what we should have, and that is calculated off of an ever even lower and that is calculated off of an even lower staffing ratio than what Suzi quoted a few minutes ago.

staffing ratio than what Suzie quoted a few minutes ago.

So we've been able to manage, So we've been able to manage, but in the back of our minds we're all thinking, All right, but in the back of our minds we're all thinking, All right, how far can we take this with how many of us there are how far can we take this with how many of us there are and how many women need to have care before and how many women need to have care before the wheels start to fall off?

the wheels start to fall off?

And this is all in southwest Idaho, Davlin: And this is all in southwest Idaho, in broader Treasure Valley, proximity to Boise.

Suzi, what are you hearing from Suzie, what are you hearing from the more far flung rural hospitals?

Kaller: Right.

Well, we know we've already had two hospitals close their labor and delivery units.

And so there is a real access to care problem, especially in our rural areas where women are having to travel further to get care that used to be provided in their home communities.

And that And that means folks are waiting longer and perhaps having to drive in and perhaps having to drive in dangerous winter conditions.

But as Dr. Souza mentioned, it also has a ripple impact on the community for access to care for women and families in general.

And Dr. Davlin: And Dr. Souza, you have St. Luke's in Boise, but you also have other facilities in Wood River Valley and in Twin Falls and elsewhere.

What's the landscape like in those rural communities versus in Boise?

Yeah, the impacts there go beyond access Souza: Yeah, the impacts there go beyond access to women's services and it's because of the fact that these systems of care that these systems of care are highly interdependent.

are highly interdependent.

So just two examples I would give, you know, first you know, first, part of the reason a rural hospital is able to pencil it out to provide anesthesia services pencil it out to provide anesthesia services is because they deliver babies is because they deliver babies.

as the OB-GYNs go, then the labor docs go.

As the OB-GYNs go, then the labor decks go.

And when a labor doc closes now a rural hospital administrator And when a labor deck closes, now a rural hospital administrator who might be operating on a pretty small number of days cash on hand has to ask, can I still afford my anesthesia team?

can I still afford my anesthesia team?

Do I have enough other surgical volume to sustain that, Do I have enough other surgical volume to sustain that, or do I need to walk away from that?

The other example is a more concerning one, I think, I think and it has to do with just primary care access.

family physicians who choose to practice in rural settings Family physicians who choose to practice in rural settings tend to be physicians who really want to practice full spectrum family medicine, which includes care of children, full spectrum family medicine, which includes care of children, care of adults and obstetrics.

care of adults and obstetrics.

If they're contemplating going to a community If they're contemplating going to a community that no longer offers, that no longer offers you know, a third of their you know, a third of their spectrum of care they've trained in, are passionate about providing, that's going to be an impediment to recruiting those that's going to be an impediment to recruiting those physicians, to those rural communities, which then has a bigger impact on care of kids and adults in those communities.

Davlin: And ultimately, we've been hearing about physician shortages, especially in rural communities for years now, long before the overturn of Roe v Wade.

Suzi, what could the Legislature have done to address Suzie, what could the Legislature have done to address some of these concerns this year?

You know, we were really hoping coming into this session Keller: You know, we were really hoping coming into this session to be able to pass a maternal health exception to the abortion ban to provide some more clarity for Dr. Kasper and others in knowing when they can intervene and when they have to refer patients out of state.

and when they have to refer patients out of state.

And unfortunately, with And unfortunately, with legal issues of Idaho's law being heard legal issues of Idaho's law being heard at the U.S. at the US Supreme Court, that kind of put a brake Supreme Court, that kind of put a brake on any legislative on any legacy relative pathway for us this year.

pathway for us this year.

I think for us, I think for us, regardless of what the Supreme Court rules later this summer, we feel we still need a health exception later this summer, we feel we still need a health exception to help allay some of that uncertainty to help allay some of that uncertainty and fear and fear on the part of physicians on the part of physicians and on the part of patients.

and on the part of patients, and make sure that pregnant And make sure that pregnant women in the state of Idaho who are experiencing women in the state of Idaho who are experiencing some complications can get the care they need when they need it in their home communities.

when they need it in their home communities.

Davlin: You can find our full conversation online at YouTube.com/IdahoReports Each year, it seems the House and Senate face off over disagreements on budget and policy, and this session is no different.

This week, the Senate voted down multiple budget bills, including appropriations for the Department of Administration and Idaho Transportation Department, over concerns that the Budget Committee was trying to block the sale of the former ITD facility.

And on Thursday, the Senate voted down a health and welfare appropriation over federal funds to provide EBT cards with $40 stipends over the summer for students who qualify for free or reduced lunch.

Carrie Semmelroth: This program is particularly important because in Idaho we have over 40,000 children who experience food insecurity in the summer and these rates are consistently higher in rural areas.

Glenneda Zuiderveld: We don't get to take from somebody and give it to somebody else.

That's not a charity.

A charity is when it's freely given.

And these programs would be best done locally with our churches, private companies and and organizations.

Davlin: And joining me to discuss that budget and so much more is Kevin Richert of Idaho Education News and James Dawson of Boise State Public Radio.

Kevin, it's not unusual for budgets Kevin, it's not unusual for budgets to go back to the budget setting committee, but broadly speaking, we haven't seen the Senate kill so many budget bills in such a short order.

Kevin Richert: Yeah, and it does feel like it's a little bit different this year.

I mean, the tension between the House and the Senate on budgets and really all things legislative end game, we've seen this year in and year out.

But I think the budgeting process is a little bit different and I think it kind of goes back to the new budget rules.

It may be easier for the Senate, or for the House if they so chose, to kill one of these enhancement budgets.

to kill one of these enhancement budgets, having Having already passed the maintenance budgets earlier in the session.

In a lot of the the qualms that we have seen Davlin: A lot of the the qualms that we have seen lawmakers take with these budgets.

They've been about specific things in those budgets.

It hasn't been the budget as a whole.

It's been, I don't like how much they've appropriated for these employees in the judicial system.

It's been I don't like this language in the ITD budget.

Exactly.

James Dawson: Exactly.

Or the $545,000 administrative cost for a potential summer EBT program for children, you know, within low income families to help them within low income families to help them have healthier meals during the summer.

I mean, that budget got killed from the Health and Welfare Welfare Division budget earlier this year Welfare Division budget earlier this year or earlier this week, really.

And, you know, they went back to JFAC, completely cut it out and they tried to put back in $800,000 or so from the governor's recommended budget.

Didn't fly.

Davlin: That was one of the selling points of this budget process from the Joint Budget Committee to other lawmakers is that you'll be able to go through line item by line item and see where we're putting this money.

Richert: And I think you're seeing that.

I think you're seeing lawmakers who some who don't sit on JFAC who have really wanted the opportunity to kind of isolate into areas of the budget and really drill down into line items and try to take a red pen to some of these items.

I think that's part of what you're seeing.

Davlin: The other thing we saw this week, though, was Senator Winder, during that ITD budget debate, really take issue with the Joint Budget Committee saying we we have problems with this ITD sale, the property sale, that we want to put in language to stop this from happening.

that we want to put in language to stop this from happening.

And when you disagreed with that process.

Winder disagreed with that process.

Richert: And that felt a little bit unusual, too.

I mean, we've all we've long seen tensions between the germane committees, the policymaking committees and JFAC.

Very unusual for a member of legislative leadership to go after the Budget Committee as forcefully as Winder did.

as forcefully as when they did.

But it did.

Dawson: But ITD and the Transportation Board is kind of his baby.

He was chairman for, however many years.

Yes he was.

And so he said, this is the hill he will die on to, And so he said, this is the hill he will die on to protect you know, protect the decision that the ITD board made to sell the campus.

Davlin: And we made that or we've noted that Winder felt really strongly about this.

He's told reporters this before.

So it wasn't that his objection was a surprise.

I think that what stood out to me, though, is tensions between the House and Senate are usually less personal.

Right.

It's the body as a whole disagrees with that.

It's not that the Senate wasn't on board with Winder himself saying, I don't like this.

It was that Winder really took the lead and said, I disagree with this.

And what the House has done, it seemed more like a Moyle Winder showdown.

Richert: It did kind of have that overtone.

But, you know, and I think ITD may be the most pronounced difference right now between House leadership and Senate leadership.

But there's a lot going on there where you can see the two houses in clear disagreement.

Even when they want to try to fix something.

They're very they're taking very different approaches to how to fix it.

Davlin: Education, I think, is a perfect example of that.

And the school facilities bill 521?

Richert: We're up to at least seven trailer bills.

Bills that are written to fix pieces of House Bill 521 And the basic themes here, I mean, we could spend a half hour talking about the seven bills.

Compare and contrast.

Nobody wants to hear that.

It comes down to some points that folks in both the House and Senate want to try to fix.

folks in both the House and Senate want to try to fix.

They want to try to get some money for charter facilities.

They want to try to get some money for charter facilities.

They want to try to address this whole conundrum about four day schools versus five day schools.

Different approaches between the House and the Senate about how to approach that four day, five day language.

about how to approach that four day, five day language.

But that's a big deal to a lot of school districts and a lot of charters in the state who are either contemplating going to a four day calendar or already operate under a four day calendar.

If that doesn't get fixed somehow by the end of the session, that is a big problem for a lot of districts in rural Idaho and, you know, even some some larger districts and some, you know, charters in larger communities.

Davlin: Meanwhile, that school facilities Bill 521 is on the governor's desk as of the time we're having this conversation.

He hasn't yet signed it, but he has a deadline of Saturday.

Dawson: He does.

You know, I can't imagine we're seeing any scenario in which he would veto it, considering that, you know, he and his team were part of those negotiations and it's his number one priority for the year.

It was, you know, a pretty big pretty big a pinnacle pinnacle or pillar of his State of the state address as well.

or pillar of his State of the state address as well.

But how hard will he push to get some, all, you know, maybe one of those trailers passed?

I don't know.

Davlin: What's the latest on the University of Phoenix, Kevin?

Richert: That was maybe one of the more startling developments of the week.

You had a new bill that came out of the Senate, moved very quickly through the Senate, and it was introduced Monday morning, came out of committee Tuesday morning, easily came out of committee Tuesday morning, died on the Senate floor on Wednesday afternoon.

Jimmy and I were both on the Senate floor and I was counting votes.

I was like, this thing's going to fail.

I don't think i expected to see it fail.

Mike Moyle didn't expect to see it fail in the Senate.

And he's a better vote counter than just about anybody.

Where this leaves Phoenix right now is very much in jeopardy.

Both Chuck Winder and Mike Moyle said they don't see a path for this purchase to go through.

Scott Green, president of the University of Idaho, maintains that they're looking at options.

They're not giving up on the idea.

Phoenix says that they're not giving up on an affiliation with Idaho.

Hard to see how this is going to come together at this point.

Dawson: And what's the deadline?

Is there a deadline?

Richert: There is still a May 31st deadline.

It's not really a deadline.

It's an opt out date.

At that point, you have or Phoenix could walk away.

Both sides say that they're still looking, Both sides say that they're still looking.

They're still looking for options.

But May 31st is, you know, it's only a couple of months away now.

Davlin: And I have to wonder to how much this legislative session has changed the view from the University of Phoenix.

If they say, like we have a legislature in Idaho that is has made it very clear that they don't like this deal or how it came together.

Dawson: If University of Idaho didn't tell University of Phoenix that, you know, maybe anticipate a little bit of a push of a pushback from a legislature that likes to have back from a legislature that likes to have pretty firm oversight over the higher ed environment in total, I think that they were not doing their job.

Richert: And I think this is one example.

I mean, we talked about the differences between the House and the Senate and the House and the Senate took very different approaches to Phoenix.

The House resolution was really designed to either delay the purchase or kill it outright, and it passed easily.

The Senate took a very different approach.

They tried to get out of this nonprofit model that may or may not be constitutional.

They tried to, you know, provide a different vehicle, a different structure, different approach to the funding.

Really trying to salvage the deal.

And that failed in the Senate.

But to take the aggregate of what you saw between the House vote and the Senate vote, both Houses have made it clear they have real questions and real skepticism about this affiliation.

Davlin: Doesn't mean that the deal's dead.

we still have Richert: Doesn't mean that it's dead, but it makes it very, very much more difficult to see what the path forward is at this point.

Dawson: Ready for a special session?

Anyone?

Davlin: No.

Never.

Richert: Thanks for asking though, but no.

Davlin: A lot of news happened in the Senate specifically this week, including a Thursday afternoon debate about an anti-racism resolution that was crafted in response to an allegation that was crafted in response to an allegation of racist harassment for a visiting team from the University of Utah who was in north Idaho staying there for a NCAA basketball game in Spokane.

In Spokane, we have a clip of that debate.

We have a clip of that debate.

Abby Lee: There was a police report.

It was founded.

And I believe these women.

Phil Hart: I am way out of my comfort zone voting on something I know nothing about.

It could have been handled with a press release.

It could have been handled with a joint letter.

Brian Lenney: I could be wrong, I don't know.

But I haven't seen any actual evidence of this happening.

Daniel Foreman: The people who should be apologizing are the people who committed the act.

who committed the act.

Now, I know the resolution is not offered as an apology, Now, I know the resolution is not offered as an apology, but I just felt compelled to stress that point that we as a state have nothing to apologize for to anyone.

Davlin: Ultimately, even though a lot of those senators expressed skepticism about the resolution and even the allegations themselves.

about the resolution and even the allegations themselves, All but one voted to pass that anti-racism resolution.

This comes after the governor condemned the the incident after the incident, after legislative leadership legislative leadership condemned the incident, after people have been reaching out to the University of Utah.

Jimi, Jimmy, they're obviously the the worst part of this was the racism, you know, in the allegation, the fact that these women felt unsafe, too.

There are also potential implications down the road for Higher Ed recruitment and Idaho.

Dawson: And I think that that's been something that the whole University of Idaho, LCSC, NIC, all of those institutions have been trying to rehab since the late nineties, early have been trying to rehab since the late 90s, early 2000s, when you had the Aryan Nations in Hayden Lake until they went bankrupt because of that lawsuit.

You know, ISU has also had problems in the past, more recently with international students.

So it's not like Davlin: And acts of racism The acts of racism against them.

against them specifically.

Dawson: Correct.

Yes.

And so this isn't a new problem, but it's certainly one that they would not want to see pop up in the media again and again every few years.

And so I would imagine that that this, a fairly immediate push after all of these fairly immediate push after all of these allegations came out to try to rehab the situation and try not to lose anyone enrolling in these institutions.

anyone enrolling in these institutions.

Richert: The debate Thursday was a flash point, and I think it's an important flash point for Idahoans to see.

But I don't think we ought But I don't think we ought to lose sight of the fact that underneath all of this are some policy issues that lawmakers have really struggled with and have really had and have really sent mixed messages about.

You know, the week started on Monday with the governor posting a photo with Senator Craig Berndt and Representative James Petskey, hailing the passage of a new law that bans diversity statements in college and university hiring, also college and university admissions.

A lot of that was already in the state board policy, so the law doesn't really do a whole lot of, didn't do a whole lot that wasn't already in effect.

But posting that photo on Twitter drew a very predictable response, a very predictable backlash.

And then you layer in this ongoing debate about DEI on campuses, should it be on campuses at all?

Is it funded by state money?

It's not.

It's not funded through state appropriations, even though we had a long and really kind of off point debate about that on the House floor on Wednesday.

Yeah, this legislature has sent a lot of you know, mixed messages you know, mixed messages about all of these diversity issues.

about all of these diversity issues.

And ultimately, Davlin: And ultimately, it's not going to be the end of those conversations, they made that clear.

Richert: No.

If anything, one of the things that came out this week, the Senate introduced a resolution that would create an interim committee to look at DEI.

Some of the language in that resolution says that the state should not be funding DEI.

Well, we're not.

It's being funded through the student fees that are optional.

It's being funded through donations.

It's being funded through sources that are not state appropriated dollars.

Davlin: Jimmy, we have 30 seconds left.

What are you going to be watching in these final days, hopefully, of the legislative session?

Dawson: Yeah, fingers crossed.

I mean, the Senate amended the latest, you know, quote unquote, library porn bill that is up for debate next week.

You know, you have the House passing that Texas style immigration law earlier today, Friday, that could be heard by the House and then a handful of social bills as well in the Senate just hanging around.

Davlin: And the immigration bill.

You have more on that at Boise State Public Radio.

Dawson: Troy Oppie would.

Davlin: Troy Oppie, would.

Perfect.

All right.

Thank you so much for watching and we'll see you next week.

Narrator: Presentation of Idaho Reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.