While the Idaho Legislature wrestles at the 11th hour with a bill to help 78,000 poor Idahoans who can’t get health care, opponents of federal funding for such programs have unsheathed their long knives, hoping to skewer the plan.
At the same time, changes to the bill and heartburn over it within the Republican caucus make it equally possible the proposal could die from a thousand cuts before the Legislature adjourns this week, perhaps as early as Wednesday.
Republican lawmakers were tight-lipped Monday in discussing the bill – which is to say, they wouldn’t. Not so the Idaho Freedom Foundation, which went into its full court press to stop the bill.
The group’s Facebook page sounds the alarm: “Tell Idaho lawmakers: Say NO to more Obamacare!” a post reads, giving the phone number for the Capitol switchboard so people can call their legislators. That was followed by two more posts on the subject Monday, one linking to a post on the group’s website that urges legislators not to “ram through Medicaid expansion at the last minute.”
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The analysis in that post is a little off, in the following ways:
▪ The IFF says the new bill is much like an earlier session bill to implement a customized Medicaid expansion plan for Idaho via a waiver from the federal government. Other states where political opposition to expansion ran high sought and received similar waivers that tempered the opposition, largely by giving the states more control over how the programs would be structured.
About the only thing that’s the same in the two bills is the concept of a getting a “waiver.”
The new bill authorizes the state Department of Health and Welfare to seek federal approval for a much different kind of health care program for the 78,000, a managed care plan that would rely on the proved successes of pilot programs here that focus on community-based health networks to deliver primary and preventive care. Those programs, roundly praised in the Legislature, move away from costly fee-for-service models and aim to keep people out of hospitals and emergency rooms.
While it might be open to debate whether the Legislature actually needs to sign off to get such an application going, that’s what the bill asks them to do. Lawmakers get a second chance to stop it next year if the application is approved but they don’t like the program.
None of that is in the earlier bill.
▪ Medicaid expansion actually deals with helping two distinct populations get health care: Those at or below the federal poverty line – in Idaho, that’s the gap group of 78,000 – and those who earn up to about one-third above the poverty line. The proposed bill only addresses the “at or below” group and does not mention the others.
The Freedom Foundation sees that as a ruse while proponents lay the groundwork for full expansion. In fact, the new bill omits the upper income group because Idaho’s state health insurance exchange already covers that population, and the state estimates that 75 percent of the affected group is already in the exchange.
▪ IFF cites an updated study I wrote about in February that revised the 10-year estimated costs to the state of implementing expansion. In 2014, the actuarial firm that did the study estimated a $173 million savings to the state over 10 years. Updating the ten-year projections this year, it projected a $187 million cost.
The Freedom Foundation harps on the $360 million swing as a sign that costs are out of control. What it omits is that the revised study moves the projection one year farther into the future, omitting big savings for 2016 that Idaho missed by not implementing expansion and adding costs projected for 2026.
Costs are higher in the out years. Why? Because, as the study says, new census data adds 15,000 people to the mix, because it’s based on a higher insurance rate for its calculation, and because the state health insurance exchange has already reduced how much counties and the state pay to cover medical bills the poor can’t pay. Lower costs there mean lower calculated savings against them in future years, when those programs can be eliminated due to expansion.
The IFF concludes its analysis saying that lawmakers should not act in haste and “rush such an important decision.” They haven’t made the same protest about the new tax cut bill that emerged in a House committee Monday. (Update: IFF tweeted out a message Tuesday morning, saying they did oppose hasty action on that bill.)
Sure, components of that bill have been kicking around all session. But the elements of the Medicaid expansion bill have been reviewed and repeatedly recommended for four years.
With the clock running down, it’s a nail-biter for sure – with real nails, the 10-penny kind.
Note: This column was updated Tuesday after the IFF posted a message on Twitter regarding its position on the tax bill.