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.

Davlin: Idaho has no medical school and currently relies on a multi-state agreement to educate and place Idaho medical students.

But a legislative proposal might undo that agreement, and some doctors are concerned.

I'm Melissa Davlin, Idaho Reports starts now.

Hello and welcome to Idaho Reports.

This week, Doctor Mary Barinaga and Doctor Joseph Holmstead join me to discuss the implications of Idaho exiting the Multistate WWAMI medical education program.

Then Kevin Richert of Idaho Education News brings us up to speed on education bills making their way through the legislature.

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

On Wednesday, the House passed a bill in a 38-32 vote that would require the state to ask the federal government to grant 11 waivers regarding Medicaid expansion, including adding work requirements and capping the number of enrollees.

If the federal government doesn't grant those waivers, the state would repeal expansion in its entirety.

An estimated 90,000 Idahoans are currently enrolled in Medicaid expansion, and lawmakers have long expressed concern about Idaho's ballooning Medicaid budget.

Ilana Rubel: For seven years, this body said we're not going to take it.

This body would not allow even a vote or a hearing on Medicaid expansion.

And people were rallying.

Thousands of folks were showing up.

They were bombarding us, begging us, begging us to pass Medicaid expansion.

This body refused.

And it was at that point that they turned to the initiative.

Wendy Horman: Back in those days, there was no fiscal note required.

So yes, it had high percentages because nobody understood what the fiscal impact was going to be at the time.

And even if they would have included the projections, they were dead wrong.

So I'll take the CAT fund any day, which was the safety net through the counties and was $18 million in 2019, over $1 billion under Medicaid expansion.

Davlin: That bill now goes to the Senate.

As of Friday, there aren't yet any bills that would restore the catastrophic health care fund or county indigent funds, which previously paid for health care services for uninsured people prior to Medicaid expansion.

On Friday, Secretary of State Phil McGrane joined lawmakers to unveil legislation to increase transparency in lobbying and campaign expenditures that come from out of state.

The legislation comes after a massive influx of spending in last year's primary and general elections.

Kelly Anthon: The message we want to send to those folks who are not disclosing where they get their money is that Idaho is not for sale.

We want to make sure that when their messaging goes out from out of state into our small communities, we want people to know where that money's coming from.

Phil McGrane: And if you're the candidate on the receiving end of, say, an attack ad, and you're not going to know who paid for it or what's going on for months, or more importantly, you're a voter who gets a mailer and you want to find out who is this coming from?

Is this from in-state, out-of-state, or anywhere else?

There's not enough frequency.

And so really, one of the big things this changes in is updating to 48 hour reporting for independent expenditures, increasing even more frequent as we get close to the election.

So 24 hour reporting as we get closer.

Davlin: We'll have more on those election bills next week.

On Monday, Presidents Day, Idahoans across the state protested federal budget cuts by President Donald Trump's administration.

Hundreds showed up at the statehouse in Boise, while others protested in Salmon, Stanley, Twin Falls, Idaho Falls, and McCall.

Those protests coincided with news that late last week, thousands of federal workers across the country received word that they had lost their jobs.

Those indiscriminate cuts affected employees in their probationary periods, meaning they had been in their positions for less than two years.

According to the Idaho Department of Labor, in 2023, there were more than 13,700 federal workers in Idaho.

The department tells me that the federal government hasn't informed the state how many Idahoans were fired.

This week, I talked to a number of federal employees who had lost their jobs, many of whom didn't want to be named for fear of retaliation, either from their former employers or members of their own communities.

One lost their job with the Bureau of Land Management, where they worked on getting critical supplies to wildland firefighters.

Kyle Compare lost his job with the U.S. Geological Survey less than a year after moving from Florida to Boise to work on water projects across southern Idaho.

All received the same form letter, saying that their quote, knowledge, skills and abilities do not meet the department's current needs, unquote.

Everyone I spoke to said they had no previous indication that their performance had been an issue.

On Thursday, I spoke to Clare Vergobbi, one of the several employees let go from the Sawtooth National Recreation Area last week about how the layoffs might impact services for visitors.

Clare Vergobbi: We lost our visitor services and admin crew for the entire district.

We lost our entire trails and wilderness crew.

The folks who are, like, out on the trails, clearing the trails, packing trash out of the wilderness.

Educating visitors.

Our recreation program took a huge hit, like for front country recreation, which for the folks, you know, dealing with campgrounds and cleaning the bathrooms.

And our fish and range programs took a huge hit, too.

So I think that everyone who's left is going to do as much as they possibly can again, to provide the services that that folks expect from us.

But, we had 16 folks fired from the SNRA of 37 total permanent employees, which is 43% of our workforce.

And I don't think it's going to be possible to fully.

You know, I don't I don't know what they're going to do.

Most probationary periods for the Forest Service at least are 1 to 2 years, depending on the job and the type of appointment.

So they're pretty long probationary periods.

Probationary periods also restart quite frequently.

So if you move from seasonal work into a permanent job, your probationary period restarts.

It doesn't matter if you had ten seasons of seasonal trail work.

If you get on permanently, you start new.

If you move from a non supervisory role to a supervisory position, oftentimes your your time restarts.

If you're, you know, move from one job to another, one permanent job to another.

Sometimes the circumstances mean that your probationary period starts.

So.

Most of the folks who were terminated in this, at least on our forest, were not actually new employees.

You know, I have a coworker who was terminated after over a decade of service, and probationary employees are much easier to fire than any other employee, for sure.

But you do still have to have a reason, and those reasons are usually related to misconduct or, performance issues.

And so everyone I know with the Forest Service, every letter I've seen, everyone received the same form letter with the same reason for termination.

And that reason was, the agency finds, based on your performance that you have not demonstrated that your further employment with this agency would be in the public interest.

And for this reason, essentially, you're being removed from your position.

There was no evidence of that fact.

I have never received anything other than satisfactory or exceeds expectations on a performance review.

I have received commendations for my work.

That's all reflected in my personnel file.

And usually, if you are terminated, even as a probationary employee, you they have proof of that, you know, they have proof of the reason behind it.

But it's simply there is no proof that I ever had any performance issues.

And that goes for, for just about everyone who was terminated.

All of my coworkers, the ones who were terminated, and the ones who are still there are incredibly dedicated and hardworking people.

Davlin: Meanwhile, Idaho Republican Party Chairwoman Dorothy Moon put out a column on Thursday saying that the cuts were exactly what people voted for in November, writing, quote, “Critics whine about the cuts, citing public lands management struggles.

But what they won't tell you is how layers of federal bureaucracy have operated unchecked for decades.

The majority voted against this dysfunction, and now the entitled elites who benefited from it are finally being reined in.” Moon went on to say that the actions are another sign that President Trump is keeping his campaign promises.

Idaho doesn't have a medical school and currently relies on a multi-state agreement called WWAMI to educate medical students.

Earlier this month, the House introduced a bill that would remove Idaho from the WWAMI arrangement.

If passed, the bill directs the state to designate two other medical education programs, either in Idaho or in neighboring states.

The bill's statement of purpose cites a lack of room at the University of Washington, where current medical students go, as well as the university's unwillingness to sign an amendment that restricts the use of Idaho state funds for abortion in accordance with Idaho law.

But the university has now signed an amendment dated February 14th saying neither the University of Washington nor Washington state use Idaho funds for abortions or abortion related activities.

I reached out to Bill's sponsor, Representative Dustin Manwaring, for comment, but didn't hear back before taping.

On Friday, I sat down with WWAMI assistant Dean, Doctor Mary Barinaga and family medicine resident Doctor Joseph Holmstead to discuss their concerns about the bill.

Thank you both so much for joining us.

First of all, for those who aren't familiar, what is WWAMI?

Mary Barinaga: WWAMI is a five state regional medical education program.

It's been around for 53 years.

It's made up of the states of Washington, Wyoming, Alaska, Montana and Idaho.

And it brings, access to public medical education for the citizens of those states.

Davlin: What about the proposal are you concerned about?

Barinaga: I'm really concerned that there's no plan for what happens next if WWAMI is defunded.

So we’ve had this very critical part of the physician pipeline, the medical school part.

And there's no plan that that can be just plug and play and take over in two years.

Such that the bill, the bill states that in 2027, this new program would start.

And it really takes a long time to get that infrastructure in place.

There's no infrastructure in place.

And so I fear that there would be a big gap in the training of physicians in Idaho.

Davlin: It's basically there's there's no existing agreement with a new medical school to step in and fill that gap.

You you mentioned the physician pipeline.

We currently have a physician shortage in Idaho.

How acute is that?

Joseph Holmstead: I grew up in Middleton and over in Middleton we at least and I know throughout the state it is it isn't an acute shortage.

So Idaho right now ranks 50th in terms of physician population per capita in the nation.

And right now waiting lists are just terrible.

We're talking six months to even a year or more to get people in to see for for new patients.

And while people are struggling to get in to see physicians, people are just it.

People are turning to whatever they can in the meantime, you know, friends, family, the internet, and.

Davlin: To treat any ailments that they may have.

Holmstead: To treat any ailments.

And that's definitely how I grew up, you know, like it's it's hard.

And I think another part of that is the working class is also, it's very difficult as a working class person with crummy insurance to go see the doctor, you know, and, and this, this proposal, I do not think that it will aid in the physician shortage in Idaho.

Davlin: And the physician shortage in Idaho isn't a blanket shortage that's the same everywhere in the state.

It is more acute in a lot of rural areas, especially.

Barinaga: It is.

If you if you look at what areas of the state need doctors the most, there are it's about 97% of the state is a health professions shortage area.

Ada County is not.

There's a few other spots.

And then if you look at psychiatry, the entire state is a health professions shortage area.

And that's a term that means, that there's not enough, physicians to to create a workforce that meets the demands of Idahoans.

Davlin: You recently graduated from WWAMI.

What was it about WWAMI that, brought you to Idaho?

Brought you back to Idaho?

Holmstead: Yeah.

So first of all, WWAMI is an unmatched program in terms of quality.

And it is is very much the envy of the nation in terms of how amazing of a program it is and what's what's even more than that is WWAMI’s built networks right here in Idaho so that in our clinical phase of education, we can come into Idaho and study and train with the doctors with the best and brightest doctors in Idaho and no other medical school has that kind of regional network to.

And so in my case, so just to kind of give, an overview or a summary of what the WWAMI program is.

So medical school is very much divided into two phases.

And they are and are two distinct phases.

We would call it your preclinical education and your clinical education.

So your first two years or in or in WWAMI's case 18 months, you would spend your preclinical phase.

That's all nose in the book learning, studying, spending time in the anatomy and the anatomy lab.

And that's all of the learning that you would do to study for your very first board’s exam.

And that's standardized.

Every medical student takes it.

Davlin: A school setting.

Holmstead: A School setting.

Exactly.

So you're at a desk and your second phase of medical school, your clinical phase, that's the last two years, or in WWAMI's case, two and a half years.

That's the phase where you're no longer in a classroom.

You are out in the community, in the hospitals.

You are training as a physician.

So you're seeing patients, you are formulating plans, you're administering medications.

I mean, you are it is it is not the the sitting behind a desk setting.

And, I think some of the confusion that's happened with, with a lot of this is that that preclinical phase is very easily it is very easily standardize able, I would say.

So from medical school to medical school, it's going to be relatively the same, because you're all training for that same board examination that that step one that happens right in the middle of your medical school career, and then you switch into your clinical phase.

And that in terms of the meat of your education, that's where the meat of your education is.

That's where the rubber hits the road in terms of the quality of your medical education.

And what WWAMI offers is truly unmatched.

So personally, I got to spend time, you know, under glaring lights and one of the number one trauma centers in the world, you know, pulling bullets out of chest walls.

I also got to spend time in rural Alaska.

I pulled fishhooks out of people's legs, dorsal spines, and on top of all of that, to round out my education, I spent most of my time right here in Idaho spending time with doctors in this state, West Valley Hospital, Saint Luke's, the VA, Saint Alphonsus, and the best and the brightest doctors right here.

And that's exactly what I wanted to do.

I got to spend time, not only in all of those other places, but I got to be at my nephew's birthdays.

Yeah, I got to help my parents at the farm when my dad throughout his back.

Like, and this is all so important to me.

And ultimately, I got to rub shoulders with, with the residency, with the members of the residency and the program directors of where I am now, right now, my my program director for the Caldwell family medicine residency is Sam is Dr Sam Portinere?

I went to I went to high school with her son.

So these connections are just a huge part of the WWAMI program.

Davlin: As you mentioned, you're you're an Idaho kid in and you are currently practicing in Idaho.

Wouldn't that be the same, though, if Idaho had its own medical school or created a new partnership with, say, the University of Utah?

Holmstead: So that's a that's a really great point.

And that's, I think, where a lot of this is being driven from, from this place of, well, shouldn't Idaho have its own medical school?

Absolutely.

And I definitely agree.

I would love it if Idaho had a teaching hospital and we were able to in that teaching hospital, have residents and and medical students.

Currently we do not we do not have that.

And right now what we do have is the WWAMI network.

And right now there there's sort of this idea floating around that, well, why don't we cut ties with U-Dub and go to another medical school?

And an idea that's been floated around is University of Utah.

The problem is, is that right now there is not a teaching hospital in this state, and there is no teaching hospital, that there's no hospital that is required to teach.

There's no physician who signs a contract that says you are required to teach medical students.

Now, an academic medical center like the University of Washington University of Utah, this is an are required to teach.

There's nothing like that in Idaho.

And this all this whole program exists on goodwill and a prayer.

Is really what it is.

Barinaga: And I would say, Melissa, to add on to what Joseph has said, the infrastructure is just not there.

It takes time to build and I think eventually Idaho will probably have its own medical school.

But what's really important is to not stop what's happening right now until there is a landing spot for students to be able to continue the pipeline.

So, I think the thing I'm the most worried about with this bill is it's just so fast.

If we could let's get together as a bunch of stakeholders in Idaho and figure out what does Idaho need.

You know, what does the next 5, 10, 20, 50 years look like?

How do we build a physician workforce that meets the needs of Idahoans?

Because it's clearly not meeting it right now.

Davlin: This is, this has come up this session.

And you, I'm assuming, have had conversations with lawmakers who are proposing this bill.

How have those conversations gone?

Barinaga: You know, I think I view my role as just educating folks about, you know, how does how do we create a doctor?

I've actually made a visual graph that shows K-12 and then college medical school residency to show what is the process of, becoming a licensed practicing doctor in the state of Idaho.

And, and I think the more people understand, they understand how critical each chunk of that pipeline is.

You know, without medical students, you're not going to get residents.

And without residents, you're not going to get practicing physicians in Idaho.

And that that it's really important to have the entire pipeline working together and having it in Idaho.

So we don't leave.

So we don't have people leaving the state to do their education.

We know people leave the state to do their education.

There's a strong chance they may not come back.

So we're trying to grow as much of it as we can within the state.

Davlin: Dr Mary Barinaga, Dr Joseph Holmstead, thank you so much for joining us.

Both: Thank you.

Davlin: On Wednesday, in a 20-15 vote, the Senate passed a bill to set aside $50 million in tax credits that could be used for private schools.

The bill would offer a refundable tax credit of $5,000 per student and up to $7,500 per student with special needs for expenses related to nonpublic schools, including tuition.

Camille Blaylock: I refuse to let the concerns that I have overshadow the good that I think can come from this.

You know, and that bigger picture, this, this bigger picture where families have real, meaningful, choice within our state, that can meet the unique, challenges, and educational needs of every child.

This this bill is not.

This bill is not the boogeyman.

This bill is not going to defund our great public schools that we have in this state.

Jim Guthrie: If it's not public education, who’s ox is getting gored?

Is it roads, courts, fire, police?

Water recharge, correction, health and welfare?

Or maybe its potential to offer more uniform tax relief to Idaho citizens?

Senators, money is money and it’s coming from somewhere.

That bill still needs the governor's signature to become law.

Meanwhile, so many Idahoans are weighing in on whether or not he should sign or veto it that the governor's office has changed its phone tree to accommodate the increased call volume.

Voicemail: If you would like Governor Little to sign House Bill 93, please press one.

If you would like Governor Little to veto House Bill 93, please press two.

Davlin: Joining me to discuss this and other education issues is Kevin Richert of Idaho Education News.

Kevin, this bill seemingly checks a lot of the governor's boxes for what he wanted to see out of an education choice bill.

Kevin Richert: It seems to and it definitely does kind of fit the parameters that he, laid out at the beginning of the session in terms of how much money he wanted to put into a, a private school choice bill.

We'll see, though.

I mean, he is also getting a lot of pressure.

He's getting a lot of feedback, getting a lot of pressure to veto this bill.

Davlin: Well, and there is still, I think, the question that we started talking about initially, whose definition of accountability are we using?

That's come up a lot.

Who's who's looking to make sure that this money is being used appropriately?

Richert: Exactly.

And that was a big part of the debate leading up to the House Bill 93, getting through the House and the Senate and getting to the governor's desk.

You know, he left himself some openings to to act in whichever way he chooses to act next week.

So we'll wait and see how this plays out.

Davlin: A lot of people testified against this bill.

We know that people are overwhelmingly calling the governor's office and weighing in.

Are there any notable names who are weighing in with the governor specifically?

Richert: A couple things.

We have heard that there is a letter.

75 school superintendents have sent a letter urging the governor to veto this.

Also, just the magnitude of the, the public testimony that didn't get heard during the committee hearings.

Ryan Suppe, who's been covering this whole issue for us, for Ed News, he’s done fabulous work.

And one of the things that he did was he tallied up the emails that went to legislators.

It was about a 9 to 1, 10 to 1 ratio.

People opposed to this bill as opposed to in favor.

Just gives you a sense of how many people are mobilized on this issue.

It's not scientific, but that's a significant ratio.

Davlin: We should also note that we're having this conversation at about 2:30 p.m. mountain time on Friday.

The governor could still act on this before the end of the day.

When's the deadline for him to sign?

Richert: Well, and that's still up in the air.

We're waiting to see if the bill has actually reached his desk, and if it has reached his desk by now on Friday, that would give him five business days, not counting Sunday.

That would move him into next week.

Yeah.

We'll watch the governor's website very carefully to see when that bill hits his desk, what his deadline is, and when the decision actually finally does come down.

Davlin: We will wait and see.

And that was a huge part of the discussion this week.

But it wasn't the only education issue.

There was also a new proposal on the public school funding formula.

Richert: Something we have been writing about for nine years, because legislators have been talking about rewriting the funding formula for nine years.

We haven't really changed the way we carve up $3 billion of state money for K-12.

That formula has been in place since 1994.

A lot has changed in education since 1994.

I think everybody can agree on that.

Charter schools, online education, open enrollment, you know, students going from school to school to pursue classes that they want.

Davlin: And a population shift to rural areas and urban areas.

That dynamic has changed a lot in the last 31 years.

Richert: Right, a lot of demographic shifts, also a lot of challenges that school districts are facing, dealing with students special education separate of this we know special education.

There's been an $80 million funding gap that the schools are dealing with, money that they're not getting from the feds to adequately cover special education.

So the whole funding formula debate revolves around do we try to change the formula, and do we try to change the formula to put more money into schools that are dealing with higher populations that have special needs, whether we're talking with special education students, English learners, gifted and talented students, students in an alternative school.

What we have right now are two competing bills.

Superintendent Debbie Critchfield has pushed a bill that passed a Senate committee last week.

It's waiting for a vote in the Senate.

And that does lay out those kind of weights for funding it, you know, weighting for funding.

So if a school has a special education student, they would get more money for that student.

And other student weights.

Representative Wendy Horman, co-chair of the Joint Finance Appropriations Committee, she introduced a bill on Thursday that does not have weighting in it.

It says as part of the legislative intent, we want to do this at some point.

The legislature wants to pursue this, but her bill does not do that.

She wants to try to do that down the road later with new funding.

Two bills, two sides of the rotunda.

It'll be interesting to see if one prevails.

Davlin: We have just a little bit more than a minute left, but not just two bills, but heavy hitters in the education policy conversation on both sides of that issue with the superintendent and the co-chair of the Joint Appropriations Committee.

Richert: Right.

So it will be interesting to see if there's some sort of a middle ground that can be reached here, or if it becomes a showdown between the superintendent's bill and representative Horman’s bill.

Davlin: About 30 seconds left a little bit more.

What else are you watching?

Richert: We're watching for a new bill that was introduced this week that would phase out the Idaho LAUNCH program.

We're also looking at a bill also introduced on Friday, that would move all high school graduation requirements out of rule and into statute, which means, in other words, the legislature could change graduation requirements by passing a bill.

Davlin: And that has implications on how much maneuverability or how flexible those graduation requirements might be if they needed to be changed.

Richert: Right.

And it's also a control issue.

The legislature versus state agencies, in this case the state Department of Education.

Davlin: Power struggles.

Twas ever thus.

Kevin Richert, Idaho Education News.

Thanks so much for joining us.

And thank you for watching.

We have more online at IdahoReports.org We'll see you right here next Friday.

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.