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

Melissa Davlin: A new report outlines the rise in infant and maternal mortality rates in Idaho.

What can the state do to reverse that trend?

And what might some of the barriers be?

I'm Melissa Davlin.

Idaho Reports starts now.

Hello and welcome to Idaho Reports.

This week, Ivy Smith from Idaho Voices for Children joins me to discuss Idaho's rising infant and maternal mortality rates and her organization's policy recommendations to address that trend.

Then Jason Mercier of the Mountain States Policy Center explains his organization's proposals to improve government transparency ahead of the next legislative session.

But first, let's get you caught up on the week.

On Wednesday, the Idaho Supreme Court heard oral arguments on a challenge to a law dealing with administrative rules.

In Idaho, state agencies and commissions can pass administrative rules that carry the weight of law.

A bill from the 2023 legislative session said the legislature must sign off on those rules before they can take effect.

The Idaho State Athletic Commission and the Idaho Division of Professional Licenses say the new law violates the separation of powers between the legislative and executive branches.

An attorney for the legislature said justices should dismiss the complaint as the Idaho Constitution says the legislature may review any rule to make sure it's compliant with legislative intent.

The Idaho Supreme Court is scheduled to hear arguments in Babe Vote V McGrane on Monday.

Babe Vote and The League of Women Voters of Idaho argue that two recent voter ID laws violate the Idaho Constitution's equal protection clause and right to suffrage.

One of those laws eliminates student identification as a valid form of voter ID, and another creates a new no cost ID card for Idahoans who don't have a driver's license or other valid identification.

In October, 4th District Judge Samuel Hoagland dismissed Babe Vote’s petition, noting that the Idaho Constitution gives the legislature the right to impose necessary conditions within the right to vote.

For coverage of both those hearings, visit IdahoReports.org where you'll also find a link to this week's Idaho Reports podcast, in which associate producer Logan Finney discusses how habitat conditions behind dams affect mercury levels and fish found in the Snake River.

A new report released last week details a rise in Idaho's maternal and infant mortality rates between 2019 and 2021.

This comes after the Idaho legislature declined to renew its maternal Mortality Review panel, which leaves Idaho as the only state without a committee that looks at the causes of post-partum death in new mothers.

This week, Ivy Smith of Idaho Voices for Children joined me to discuss policy recommendations they hope will reverse that trend.

Thanks so much for.

Joining us this week.

What does the latest report say about infant and maternal mortality rates?

Ivy Smith: Over the past few years, we've seen an alarming trend in maternal and infant health outcomes.

We're seeing an 18% jump in infant mortality rates an 121.5% increase in maternal mortality rates.

Among other troubling trends, such as low access to prenatal care for mothers in their first trimester and higher rates of low birth weight in preterm babies.

Davlin: What year did this report examine?

Smith: This year reports.

This year's report looked at 2019 to 2021.

Unfortunately, with the effects of COVID on data collection, many of our sources of looking at this data are from many different years.

So we tried to really look at the years we saw the most comprehensive data.

Davlin: And so, you know, with 2021, the first thing that pops into my mind, as you said, is is COVID.

And we know that there were, you know, documented increases in substance abuse and use, including alcohol and documented increase in mental health crises.

And then, of course, the direct health impacts of a COVID infection on pregnant women and fetuses and infants.

Was there any correlation or any link that the report found between the increase in deaths and COVID in 2021?

Smith: Well, we weren't able to point directly to COVID.

We can make a few assumptions here and there because the main contributing factors that Idaho's maternal Mortality Review Committee's latest report found was in maternal health trends and specifically in maternal deaths.

The top contributing factor was a lack of knowledge around the significance of their health event and their lack of access to care and the financial resources they needed to receive treatment.

Davlin: When you say that, do you mean like symptoms of an infection or an adverse symptom or after effect of having birth or giving birth?

Smith: The MMRC Maternal Mortality Review Committee said that the top links in maternal deaths were surrounding mental health conditions, so this could be postpartum depression or other mental health conditions and infections.

Yes.

Davlin: And so when we say mental health conditions, we're also including, you know, deaths by suicide in the causes of death there.

Smith: Correct.

This is their pregnancy related maternal mortality ratio.

Davlin: How many of those deaths were preventable?

Smith: Unfortunately, in their latest report, they found that 88% of maternal deaths were preventable or treatable.

Davlin: What's the difference between rural outcomes and the more metropolitan or urban areas of Idaho when it comes to those maternal mortality rates?

Smith: You know, what we've seen in terms of the rural areas using Medicaid as their primary form of payment during delivery, we've seen 30% of Idaho mothers have Medicaid at the time of delivery.

And what's really important here to explain is pregnancy is actually not a qualifying event for pregnant women.

And what that means is if a woman doesn't have health insurance when they become pregnant, they are not eligible to just go and sign up for a health insurance plan because pregnancy is not considered a qualifying event, making them have to wait for an open enrollment period.

Which is why Medicaid becomes such an important piece of this conversation, because Medicaid doesn't have open enrollment periods.

Anyone who is eligible for Medicaid can sign up at any time.

Davlin: Is that a state policy or a federal policy?

Smith: For qualifying events?

You know, I think it's something that the state could explore, but I'm not sure what the federal implications would be.

Davlin: You've touched on this a little bit, but policy recommendations to address this rising maternal mortality death rate.

What are some of the things that your agency, your organization would like the legislature to explore?

Smith: Sure.

You know, we understand there are tensions rising around Medicaid.

But what's truly what this boils down to is Medicaid is the public health system that low income women and children have access to, to receive health care.

It's the system we have and it's a system that we have opportunities to improve in.

And truly, when we're looking at our recommendations, what we are really thrilled to be working with the legislature on during this upcoming session is a comprehensive maternal and infant health package which includes raising income eligibility for pregnant women and children to access Medicaid and CHIP.

Extending postpartum coverage to a full year, because as it stands now in Idaho, it ends at 60 days after delivery.

And of course, reinstating Idaho's maternal mortality review committee.

Davlin: Let's start with the income eligibility.

Why is that so important?

Smith: Right.

So for raising income eligibility, Idaho is last in the nation in providing health coverage for pregnant women and children, meaning we have the lowest income eligibility criteria in the nation.

And further, our, for pregnant women.

It hasn't been updated in Idaho since 1990, and for children it hasn't been updated since 2004.

So Idaho Kids Covered, we believe it's time for change, and if we don't act now, these concerning trends will continue.

Davlin: And in that time, wages have risen.

But cost of living has also risen substantially since 2004.

Smith: Sure.

And income eligibility is set by a percentage.

So in Idaho, for pregnant women, it's 138% of the federal poverty line, which does get adjusted for inflation.

But what that looks like in Idaho is for a pregnant woman, she has to make less than $34,000 a year to qualify.

Davlin: When we're talking about post partum care coverage, extending a year after birth, what does that care look like for people who haven't had babies before?

Smith: Sure.

So the government entity that reviews every maternal death in Idaho, the Maternal Mortality Review Committee, what they found in their latest and unfortunately last report is that about 56% of the maternal deaths happened 43 days after they gave birth.

And typically in conditions such as postpartum depression, which we are above the national average currently, those effects can take hold later on than immediately after birth.

They happen later on.

And same things with infections.

And truly, when we are looking at expanding to a full year, we're able to capture women who may need access to care later on.

And if we try to boil it down for those who haven't been pregnant before, at 60 days, you're dealing with trying to raise your newborn baby and making sure they're going and getting their checkups and appointments, and frankly, your needs take a backseat.

And so to try to get the health care you need in those 60 days is really difficult, especially when we consider the state wide provider shortages we're seeing in our state.

Davlin: Let's touch on that a little bit, because I think a lot of the conversation in the last year and a half surrounding provider shortages has focused on Idaho's abortion trigger law that went into effect after Roe v Wade was overturned in 2022.

To be clear, this report looks at data from 2021 before that went into effect.

Smith: Correct.

Yes.

Davlin: And none of your policy recommendations have anything to do with that abortion law?

Smith: Correct.

Davlin: Let's talk a little bit about that maternal mortality review panel.

Idaho right now, after that review committee sunsetted in July, Idaho is now the only state without a review committee.

The legislature was hesitant and ultimately did not renew that and the committee was disbanded.

Is this something that the private sector and hospitals could get together and do themselves without the legislature working on it?

Smith: Unfortunately, I don't see how the private sector could get involved because this information, this data is protected.

It’s under the Department of Health and Welfare, they hold this data.

They were able to share that with the committee due to the legislature enabling this committee to do so.

So without legislature’s action to reinstate this committee, the private sector just wouldn't be able to get involved.

But more so, we should all be asking ourselves going forward in looking at this report, seeing all of these alarming trends, how are we supposed to make sound policy solutions that meet the unique needs of Idahoans, if we don't have Idaho specific data anymore?

Davlin: You, or you mentioned trying to increase Medicaid coverage for pregnant women and making pregnancy a qualifying event to sign up for Medicaid, this legislature is very hesitant to do anything to expand existing Medicaid programs and is looking at reining a lot of those costs in.

How do you sell this to lawmakers, considering that hesitancy?

Smith: Sure.

I'll say this.

Every maternal and infant life in Idaho is precious and valuable.

We have to do all that we can to ensure the health and safety of our mothers and children in our state.

And if by raising income eligibility, by expanding postpartum coverage, we can ensure that more mothers and children have access to the life saving care they need when they need it.

Davlin: Have you started having those conversations with lawmakers already?

Smith: Absolutely.

And we are very thrilled to be working with them during the upcoming session on what we know is a top priority for all Idahoans, the health and safety of Idaho moms and their babies.

Davlin: How are those conversations going?

Are you optimistic?

Smith: I'm optimistic.

We're having really great conversations.

And truly, I think we all know right now this is a top concern and we want to ensure that moms and babies get the healthy start in life that they deserve.

Davlin: All right.

Ivy, thank you so much for joining us.

Smith: Thank you.

For more, including a link to the report on maternal and infant health and mortality in Idaho, visit IdahoReports.org Every year, important debates over tax policy dominate the legislative session, but outside of state agencies, do Idahoans know how their taxpayer dollars are being spent?

Jason Mercier, vice president and director of research for Mountain States Policy Center, joined me this week to outline some proposals aimed at making government spending more transparent.

Jason, thank you so much for joining us this week.

For those who aren't familiar, Mountain States Policy Center is still fairly new, what do you do?

Jason Mercier: Well, thank you, Melissa for having me today.

We are a public policy group, so we deal in policy.

We don't deal in politics.

And that means we are looking at the issues.

Our coverage area is Idaho, Montana, Wyoming, and a little bit of Eastern Washington.

And when you're looking at a regional part of the country, you're going to get into some of those federalism issues, the best practices, seeing what works and doesn't work in different environments, economies.

So we're looking at things from that policy prism of what are the ideas we can give state officials on fiscal policy, tax policy, governance, transparency, education.

Our prism that we look through is not a free market.

So how do we empower entrepreneurs to grow their businesses?

How do you empower individuals to take advantage of the economic opportunities of the area?

And that's how we're going to be kind of approaching policy.

So you're not going to be seen us engaging in a political debate.

We're on an ideas basis on policies.

Davlin: You have some policy recommendations regarding government transparency this year, and before we get into those specifics.

You know, we as journalists talk about government transparency and its importance all the time, but why is it important for the average citizen?

Mercier: You know, when Benjamin Franklin was asked, what has the Continental Congress created, it was a republic, if you can keep it.

And to have a republic, to have that form of government you maintain, you really need to have the citizens in the driver's seat.

And you cannot do that without access to the information about what public officials are doing and how they're running the country.

And if you look at the very beginning of Idaho's Constitution, it wastes no time.

All political power is inherent in the people.

But the people can't exercise that if they don't have the information to what's being done on their behalf.

And when you look at Idaho's public records laws and open meeting laws, they're fairly good.

We just need to make sure that they're being followed.

But at the same time, when you look at our legislative process here, that's about to start, that really is supposed to be the opportunity for the citizens to be involved in their governance, to tell their elected legislators what policies they'd like to see advance.

But if you don't have access to the information about what's being considered and when it's being considered, it's hard to testify.

It's hard to provide that valuable information.

And sometimes policy will suffer if you don't have that transparent process built in.

Davlin: You mentioned Idaho's open meeting laws and the legislature.

The legislature is allowed to make its own meeting rules and beholden to the same open meeting laws as other government entities in Idaho.

One of your suggestions is requiring a three day meeting notice for the legislature and for new bills.

Can you can you walk me through what that would look like?

Mercier: Yeah.

So the legislature in Idaho is exempt from the open meetings law, but it does have its own legislative rules that they adopt as how they're going to govern their proceedings.

And when you look across the country, a similar thing you'll see in other legislative rules are these waiting periods.

Now, if you have a longer legislative session, it might be a week, or five days, because Idaho has shorter sessions, what we are advocating for is that when they come into session here in a few weeks, they amend their rules to require a three day public notice of not only when a hearing is going to be held, but the details on the agenda, what bills and what are the text of the bills.

Because we're busy, you know, you're running your business, you're going to work, you're in school.

And if you don't know what's being considered and what the actual details of that are, it's hard to rearrange your schedule, even if you're doing remote testimony and you don't want to drive to Boise to testify in person.

So this helps the citizens not only be more involved in the governance, but the legislature as well, because now they can have a more informed debate.

When you think about the Idaho legislature, it's a little bit unique in that they don't have the staff for individual lawmakers.

So that public hearing sometimes can be their first look at a concept.

And that's where providing this three day notice with the actual bills, with the actual text, will allow them to better understand what they're considering, and for citizens to participate in a more informed way.

Davlin: Especially considering the nature of Idaho and how so many citizens live away from that government center of Boise.

How would that requirement, though, look at the end of session when so often we see a flood of last minute omnibus type bills coming through that are really, really critical.

And there have been a handful of lawmakers working on those throughout the session.

But as you mentioned, for a lot of folks, that's the first time that they're seeing it hit their desk.

Realistically, though, at the end of the session, when people are trying to get out of town, can you require that three day notice?

Mercier: Well, so, definitely on policy bills as we're going through the process.

Now, when you're looking at appropriation bills, these are 100 page documents, it's a little bit harder to do a three day thing.

So what you would like to see happen when JFAC comes out with their final recommendations, that that sit at least for 24 hours before there's any action on it.

Now, 24 hours to go through hundreds of pages, most people aren’t going to be able to do.

But it at least experts, those who know the funding issues, a little bit of time to say, hey, you might have missed something or maybe consider this.

Now, when you look at the rules, there's technically those type of waiting periods between they're called readings, first reading, second reading, third reading.

But sometimes legislative rules can be a little bit like the pirate code, but you still want to see that at least that intent in there and hopefully followed.

Davlin: Not all of your proposals have to do with the legislature.

A lot of them have to do with taxes and how the government is spending money.

Let's talk a little bit about the tax transparency website.

What's the vision there?

Mercier: Yea, so the vision there, if you look right now with what Controller Woolf has done on Transparent Idaho, getting a lot of detail on the spending, on the budgets, being able to kind of see where the money is being spent and how.

Fantastic resource.

What you want to do is now add the tax side of that.

So the concept on a tax transparency website, when you look at Idaho right now, there are more than 1,200 taxing districts.

These are individual government entities.

They have authority to impose a tax liability.

Now, as a taxpayer, I'm paying taxes, but to whom and for what?

So what this tax transparency website would do is you would enter in your home address or your business address.

You would see all the taxing districts or subject to you at which rates and not for your actual tax liability, but for an educational basis, what your potential tax burden would be.

Now this gets into not only providing that transparency on what you're paying and to whom, but you can get into some tax competition.

Let's say I want to open my business in Nampa versus Twin Falls.

What would my tax liability be?

If I want to move to Meridian, you know, versus Nampa.

What would my cost of my home be?

So it just kind of provides a little more transparency for the citizen and the business to see what they're looking at as far as taxes.

Davlin: Idaho, as you mentioned, has more than 1,000 taxing districts, about 1,200.

How hard realistically would this be to pull off if you need buy in from all of those taxing districts to submit that information in the first place?

Mercier: Well, I know Controller Woolf is already trying to move in this direction as far as getting that information from the taxing districts.

And I think what would facilitate this is if you had more standardized reporting.

Now they know what they're leveeing in taxes.

They have to because that's how they are able to get that money from the citizens.

It's just a matter of getting that standardized reporting to whether it's the controller's office or another entity that they can they can pull from that database.

Davlin: This kind of goes hand-in-hand with another one of your proposals, tax receipts, where basically a taxpayer would be able to figure out or find out exactly how much of their tax burden is being paid into which bucket.

Can you walk me through?

Mercier: Yeah, This is something Utah has been doing for several years, and it's a really fun resource.

You know, when you go shopping, you'll get your line item receipt.

You can see where your money went to.

And if you can't remember what you were spending, that's a pretty good little snapshot.

So what the taxpayer receipt does is the same thing.

So how Utah does it, you enter in your household size, your income, your home or your rent value, how many cars you have and how much you drive.

Now, this information is not kept by the government.

This is just to used to run this estimate.

And then it will take those data points and tell you, well, here's how much your state tax liability is going to be, how much you’re going to pay in gas tax, property tax, sales tax, income tax.

And then it translates that amount of taxes into a proportional amount of the budget.

So from that, you say, well, this is how much went to criminal justice, Here's how much went to higher ed, here's how much went to agriculture.

So it just kind of takes these billion dollar budgets and puts them into a little more digestible sizes.

Davlin: The Idaho courts have an almost identical feature on their website, breaking down what court fines and fees go to if you have, you know, $100 fee that that you pay.

This is how much goes to drug courts or whatever.

Are there other areas of government where this concept might make sense?

Mercier: So I guess a little similar thing is when you think about schools right now and education spending and you know, parents and want to know, well, what's happening in my schools.

So when a levy or a bond comes up, I can make a good informed decision about additional resources needed.

So what we're working with Secretary Critchfield on is what we're calling the Public School Transparency Act.

And this would require standardized information from all school districts on page one of their budget.

Now that school district budget is a big thing, you may not really understand what you're looking at, especially if you're trying to compare between districts.

And what we would say needs to be on that very first page is, you know, obviously the total spend, how much is being spent per student, how much is actually making it to the classroom.

What are the wages and benefits for administrators and teachers?

And what's the ratio of administrators to teachers, to students?

So we can kind of start to get a feel for these investments that we're making and what's actually getting to the classroom, And then we can kind of have a determination when that levy or bond comes up, is additional resources needed.

Davlin: You know, a question on that.

You all of that information is so important.

You know, the more information, the better.

But at the same time, you can't always tell the whole story using a spreadsheet or using infographics.

A lot of times you need information, you know, this is why we had to spend more money in this area this year because we had this special situation or students who had these specific needs.

Is your proposal enough to paint that whole picture for taxpayers?

Mercier: Well, I think right now you're getting into additional data points you can add to this, right?

Because you look at English as a second language, obviously, there are going to be more intense requirement investments, Special ED.

Now we're just talking about the appropriations.

We're not talking about the results.

That's the other side of this coin.

Then you start to add to this, and you can see we'll have our test scores change what's happening in reading.

You know, and when you're thinking as you're getting a little bit older in some civic education or an economic education.

And I will say Idaho, it's done a great thing as far as the financial education.

So people can understand how to do a balance sheet, a checkbook, start saving for their home.

So these are some of those now you're going through the results.

You could also add a future, whether you're going to like a website of this.

Davlin: One more policy proposal that you had was gas tax stickers.

Can you can you walk me through that proposal?

Mercier: So let's go back to when we go to the grocery store.

We get, we see what we have purchased, how much that is, and then we see how much the sales tax was.

It's not just put into the total price.

When you go fill up at the pump right now, you're just getting the total.

That's including the about $0.32 of Idaho gas tax and the $0.18 a federal gas tax.

So what this concept is that several states have done with these stations, these pumps have to be inspected by the state.

So when they are what we are encouraging to have happen is a gas tax sticker be applied to each pump that would show how much is the state tax, how much is the federal tax, Kind of like a gas tax receipt.

So when you're seeing, well, it's $3.50 a gallon, $3 of that is the gas and $0.50 of that is the tax.

Davlin: In places like Ohio and Utah, where this has been implemented.

And more broadly speaking, the more information people have about how their taxes are being spent and how that's being parceled out.

In general when taxpayers know more about where their money is going, do they tend to be more supportive of, you know, paying those taxes or approving additional requests through bonds and levies?

Or do they tend to say, hang on, wait a minute, I don't know if I agree with this, or does it depend on the district?

Mercier: It's going to depend upon what the results are, because right now we just hear a conversation of a need without the being able to evaluate what's currently happening and then what are the results.

Basically what you'd like to see happen.

This is a different topic I'll throw for you that we'd eventually like to see the legislature do as well.

It's called performance based budgeting.

So rather than when you open up a budget, it just being a line item of appropriations, it actually gives you a high lev result is.

And so an example of this would be I wouldn't advocate that we have a budget as big as Texas because Texas’ budget is about 1,500 pages.

But it's that size because with every appropriation they're identifying a high level outcome.

So now you can have that conversation as a lawmaker.

When an agency comes to you and says we need X amount more, it's not just, well, was that because of inflation?

Was that because of headcount or what result are you trying to achieve?

Because ultimately we're spending these tax dollars to get a service from the government, not just a spend.

And if we're not focusing on those results, we're not having the full question answered.

Davlin: Jason Mercier, Mountain State's Policy Center, thank you so much for joining us.

Mercier: Thank you.

For more public policy news, be sure to subscribe to the Idaho Report's weekly newsletter.

You'll find that link to subscribe at IdahoReports.org Thanks so much for watching and we'll see you next week.

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.