Medicaid expansion: It's a math problem, not an ideological issue

When they rejected a state-run health insurance exchange — an idea supported by many business leaders — Idaho legislators governed by ideology.

That was this year. Will 2013 be any different, when lawmakers wrestle with another health care issue, expanding Idaho’s Medicaid program?

I hope so. And I actually think this could be more than just ungrounded optimism.

The obvious difference is the timing. The 2012 health insurance exchange debate, such as it was, coincided with the Legislature’s waiting game on the U.S. Supreme Court’s ruling on the federal health care law. Some lawmakers assumed the court would declare the health care law unconstitutional, and they saw no need to create an exchange — an online health insurance marketplace, and one of the federal law’s hallmarks.

Their assumptions on constitutional law shot, legislators must decide again where they stand on an exchange. (The clock is ticking. States have until November to make plans to create an in-house exchange, or accept one of the feds’ making).

Meanwhile, lawmakers have another big question, courtesy of the Supreme Court: whether to accept federal dollars to expand its Medicaid program. According to 2010 U.S. Census Bureau data, 83,000 to 138,000 uninsured Idahoans could qualify for the coverage — and at the outset, the feds would cover the entire bill. By 2020, states would have to cover 10 percent of the bill, if they choose to expand the program.

That’s where the issue gets dicey for legislators, who have watched the state’s share of Medicaid costs mushroom, largely at the expense of public schools and higher education. I can understand the hesitancy — but this is, ultimately, a math problem. Elected officials can solve puzzles of this kind, if they focus on the math and check their ideology.

This week, Betsy Russell of the Spokane Spokesman-Review crunched the numbers and arrived at an eye-opening conclusion. Expanding Medicaid would greatly ease the pressure on the state’s catastrophic health care fund. The so-called “CAT fund” ran $51 million in 2011-12, and is expected to top $60 million this year, with money coming from state coffers and local property taxes. By accepting the feds’ help on Medicaid, Russell said, Idaho could save $380 million over six years.

That’s a compelling number — certainly enough so to frame the debate. Any legislator or candidate who flatly rejects Medicaid expansion is speaking from ideology. It’s really that simple.

I am hopeful that this decision will be driven by fact. To that end, Gov. Butch Otter established the right tone by appointing a task force to study this decision. Otter’s work is by no means done. Don’t forget that Otter voiced support for a health exchange before the 2012 session. But Otter undercut his own case by claiming, erroneously, that refusing to create a health care exchange would jeopardize $300 million in federal Medicaid funding. Discredited on the math, Otter then stood by silently as the health exchange debate turned on ideology.

Can the governor and legislators do better by their constituents on the Medicaid issue? I hope so.

get out the vote

I would vote for Betsy.

Going from 19mil to 60 million in 12 years is not 'ballooning'. It's about 10% annual growth- pretty close to the inflation of medical expenses.

So let's say the Medicaid replaces the indigent funds.
Does anyone think the counties will REDUCE their tax rates to pass the savings back to the taxpayers?


what I want to know

is why a reporter has to be the one to come up with these numbers. Why didn't the state figure this out for itself?

Some have been saying it

I appreciate that Betsy did a good job reporting this story. But some of us have been trying for almost two years to have the legislature (and the Governor) get past the Obama bashing and look at a business plan.

When Sen. Risch falsely stated the cost to Idaho while the ACA was being considered, I pointed out a more realistic projection. His staff refused to cave until the Legislative Service Office analyst verified it.

Through meetings of the CAT board, Assocoation of Counties, and Chairman McGeachin's "bible studies" on the ACA in House Health and Welfare, the likely outcome was explained. But since the voices were usually Democrats, they were not as believable as the anti-Obamacare rhetoric. Wayne Hoffman and the healthcare "experts" of the Idaho Freedom Foundation held more sway than hospitals, doctors, health plans, public health or County officials.

So now we are staring down the barrel of the Nov. 16 deadline on the State Health Exchange decision. Business analysists suggest that a federal small group exchange might cost Idaho businesses $500-1000 more per employee per year. We know that Medicaid expansion is a winner, that state and local taxpayers are paying more through the Indigent program and the cost shift for those uninsured. The likely financial benefit can be demonstrated.

I have not given up on the idea that the State will do the right thing for citizens, that the Governor and Republican legislators will look past the rhetoric and make a good "business plan" based decision. But that might be the triumph of hope over experience.

You speak

as if any politician or governmental agency has ever solved any problem with taxpayers money.


Why do we elect these idiots that would cut off their nose to spite their face?