Idaho taxpayers' stake in the national debate over health insurance reform is about to get a lot more direct. Sometime next year - probably while the Legislature is in session - the state Catastrophic Health Fund, which helps counties cover medical costs for indigents, will run out of money.

And you'll probably have to make up the difference.

The board that oversees the CAT Fund just submitted a request to the budget-writing Joint Finance-Appropriations Committee for $8 million more for the current fiscal year, but even that may not be enough. Because of the economy, the fund is being tapped at an accelerating rate and has nearly burned through the $19.7 million appropriation it received from the Legislature.

That's on top of a request for $30 million for next year, and every dime of it will be general fund money - meaning there will be less for public schools, higher education, corrections and health and welfare.

If the Legislature doesn't appropriate the money, then providers - hospitals and doctors - would have three choices: Write off the bills, potentially transferring the cost onto other paying customers; negotiate with the state for some lesser amount, or sue the state to recover the money.

Counties often bear the largest share of indigent claims because they're on the hook for the first $11,000 in medical bills, a figure that legislators increased by 10 percent last year. It's the counties that make the initial decision about who can pay and who can't.

That money comes from property taxes, and in fiscal year 2007 counties spent about $18 million to cover the medical expenses of folks who lack insurance but don't qualify for welfare programs such as Medicaid.

To curb rising costs, the Legislature ordered the Idaho Department of Health and Welfare to review medical claims to see if procedures are necessary and to determine whether people applying for indigent help could instead enroll in Medicaid. Roughly 70 percent of Medicaid claims are paid by the federal government, while 100 percent of CAT fund claims are state paid.

In the future there will be better oversight and review of the utilization, treatments and bills, but the savings will be incremental.

In the meantime, Idaho will be hard pressed to keep up with rising costs and increasing demand.

Would national health care reform help? Probably. More than 250,000 Idahoans lack health insurance.

But it won't solve Idaho's CAT Fund problem. Poor people don't buy health insurance, and even under health-care reform legislation probably wouldn't.

"I anticipate 15 (percent) of the population still refusing to buy coverage," JFAC Co-Chairman Sen. Dean Cameron, a Rupert Republican who owns an insurance and investment agency, told the Post Register of Idaho Falls. "Incidentally, that is essentially the same percentage who refuse to purchase auto insurance even though it is mandated by law."

For the moment, the key is better management, he said.

"The CAT Fund board needs to be extremely cautious in the claims they agree to pay."

We couldn't agree more.