David Adler: Idaho should adopt Ohio’s stance on Medicaid

November 5, 2013 

In words that have reverberated across the American political landscape and sharply challenged GOP opposition to the expansion of Medicaid, Ohio Gov. John Kasich warned fellow Republicans to halt their “war on the poor.”

Kasich circumvented his obstinate legislature and declared, for reasons of fiscal responsibility and compassionate conservatism, that the Buckeye State would embrace Medicaid expansion offered under the Affordable Care Act, providing health care coverage to nearly 300,000 Ohioans.

Was his message heard in the Idaho State Capitol?

In terms that appealed to social conservatives and voters of faith including, perhaps, those in Idaho who purport to embrace “family values,” Gov. Kasich, a potential standard-bearer for the Republicans in the 2016 presidential election, shared a New Testament homily with listeners: When you arrive at the Pearly Gates, St. Peter may not ask “what you did to make government small, but he surely will ask what you did for the poor.”

A Daniel come to judgment, Gov. Kasich, a former ax-wielding chairman of the House Budget Committee, denounced the cruel stereotype that the poor are “shiftless and lazy.” Some simply can’t help it, Kasich explained. He said that those who complain about those on the lists of the unemployed should ask themselves if “their grandparents worked for the WPA,” the Depression-era program that employed millions of Americans.

Last year, Gov. Butch Otter rejected the idea of extending Medicaid health care coverage to more poor residents of Idaho. His decision ignored a unanimous recommendation from the commission that he appointed to study the desirability and financial implications of the expansion program. At the end of the legislative session in late March, House Speaker Scott Bedke, R-Oakley, determined that there wasn’t enough time to consider the idea of adopting Medicaid expansion.

This time around, however, there will be more than enough time to consider and adopt a program that would provide coverage for some 100,000 Idahoans and save the Gem State and Idaho counties some very serious money. According to an analysis conducted by the Urban Institute and the Henry J. Kaiser Family Foundation, as reported by The Associated Press, Idaho would spend an additional $261 million from 2013 to 2022 to cover new enrollees through Medicaid expansion, and the federal government would send some $3.7 billion to Idaho.

Setting aside the moral strength of the argument for providing health insurance coverage and improving the quality of life for Idaho’s poor, and assessing the adoption of the program from purely a financial perspective, can Idaho find a better investment?

Adoption of Medicaid expansion would result in additional savings. States that embrace the expansion can save on health care costs for prison inmates. From 2001 to 2008, Idaho saw a 24 percent increase in its health care costs for inmates, according to a Pew Charitable Trust report that relied on figures from the Federal Bureau of Justice Statistics. An aging prison population will lead to increased costs.

In the wake of Kasich’s announcement, word is spreading that additional “red” states are considering adoption of Medicaid expansion. It’s a smart business move for legislators who subscribe to fiscal conservatism. It’s an effective means of curbing costs to counties that bear the expense of indigent health problems. It’s an effective means of saving taxpayer dollars. Best of all, it is an exercise in compassionate conservatism, an attractive bumper-sticker advertisement awaiting implementation.

Let us hope Gov. Otter and Idaho’s legislators have heard Gov. Kasich’s words. Let us hope that they are followed.

David Adler is the Cecil D. Andrus professor of public affairs at Boise State University, where he serves as director of the Andrus Center for Public Policy.

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