A.J. Balukoff: Medicaid expansion makes fiscal and ethical sense

April 19, 2014 

Today we continue our series on "Where The Candidates Stand." A.J. Balukoff's Democratic primary opponent for Idaho governor did not supply us a Guest Opinion on the topic of Medicaid expansion.

I believe every Idaho family deserves to have access to affordable health care and insurance that works for them. No one willing to work hard should be denied health care for themselves or their children. But our health care system is not sustainable. Real and effective reform is needed. Health care costs increase consistently, and health insurance premiums go up 10 to 15 percent every year.

The Affordable Care Act is far from perfect, and it is not what I would have recommended. But rather than calling for its repeal, I would prefer to work with it and try to amend the parts of the law that are problematic. The problems in the law could be resolved through cooperation and compromise.

There are some good provisions in the law.


Under our current health care system, uninsured people generally do not have a family doctor. So when they need medical attention, they go to the hospital emergency room. The ER treats patients, even when the patient is uninsured and will not be able to pay for the service.

But the emergency room is the most expensive and least efficient way to treat uninsured patients-and you and I pay for the medical care of uninsured people through our property, sales and income taxes, and our health insurance premiums.

The federal government has offered to pay 90 percent of the cost if our state will insure, through Medicaid, families earning up to $26,000 per year. This funding would come from taxes that we are already paying to the federal government. More important, it would provide health insurance to about 104,000 Idahoans too poor to qualify for subsidized health care, and save the lives of an estimated 600 Idahoans every year.

Insuring these folks would allow them to have a family doctor who could treat most illnesses and accidents without the need to go to the hospital emergency room. It is estimated that Idaho would save nearly $1 billion over the next 10 years if we expand Medicaid coverage. It would also save Idaho businesses money. We are already providing uninsured people with medical care-we're just doing it in the most expensive and ineffective way possible.

But Gov. Butch Otter chose not to even consider Medicaid expansion, announcing at the outset of the 2014 legislative session that the state's top priority this year was getting him re-elected. At least he's honest about his priorities.


Small businesses with few employees have a difficult time providing affordable health insurance for their employees. This is especially true when one or two employees have a history of medical problems. The insurance premiums are so high because the risk pool is so small.

This problem is fixed by the employees joining a larger risk pool, which is exactly what the state's existing health insurance exchange provides - the opportunity to join a larger risk pool in an Idaho-run health insurance exchange rather than the federal exchange.

Sitting on the boards of many organizations, I have always recommended actions and policies that are fiscally sound and satisfy the mission and goals of the organization. As governor, I will use those same values and priorities to set policies that make sense for Idaho - not just fiscally and economically, but also for the people of Idaho.

If Idaho is going to become a place where anyone willing to work hard can make a livable wage and get insurance so that good health care is within reach for their family, we must restore balance and accountability to state government.

Balukoff, of Boise, is a Democratic candidate for Idaho governor.

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