Idaho’s Medicaid overhaul: Why Gov. Brad Little should veto House Bill 345 | Opinion

Gov. Brad Little should veto House Bill 345, which is on its way to his desk, having passed the Idaho House and Senate with unanimous Republican support.

The bill would, among other things, have Idaho submit for a waiver that would allow it to implement work requirements on Medicaid expansion and transition the entire system swiftly to a managed-care model.

Though she is a lead sponsor of a bill that deserves to be vetoed, we commend Sen. Julie Van Orden, R-Pingree, for her work negotiating it. She killed a much, much worse bill that almost certainly would have resulted in the repeal of voter-approved Medicaid expansion. In negotiations, you have to make concessions to get the best deal you can, and Van Orden did an excellent job.

But that does not make this bill the best possible policy — or even better than the status quo. It isn’t.

The predictable result of work requirements will be that thousands of working Idahoans will lose health insurance.

Medicaid expansion covers people who make between 100% and 138% of the federal poverty level — about $32,000 to $44,000 a year for a family of four, or about $16,000 to $22,000 for a single individual. That is an extremely low level of income, but it’s very rare to have that much pay without working. Nearly everyone covered by Medicaid expansion by definition works for very low wages.

But experience from other states shows work requirements lead to tons of people being kicked out for one simple reason: a work requirement doesn’t just require you to work. It requires you to repeatedly send all kinds of paperwork to the government to prove that you are working.

Maybe you check the wrong box. There goes your health insurance.

Maybe you forget to file during the week when a family member dies. There goes your health insurance.

Maybe you face an extended internet outage. There goes your health insurance.

Maybe you don’t follow the news and don’t know about the new work requirement. There goes your health insurance.

Evidence from states that have implemented work requirements indicates that nearly everyone kicked out of the program qualifies, but either fails to file or incorrectly files the paperwork. It’s death by red tape.

Will it save taxpayers money?

Nope, it will just change how they pay.

Quite simply, there is nothing particular to Medicaid expansion that is causing costs to rise. It is driven by two key factors:

Overall, medical costs have risen at far too fast a rate for years. Rising Medicaid expenditures are an effect, not the cause, of this problem.

Idaho has a rapidly growing population. As more people move here, some percentage of them will qualify for Medicaid expansion, which causes enrollment to grow.

There are also serious concerns about how the bill might hurt the traditional Medicaid population, particularly people with severe disabilities. As the Idaho Press reported, Christine Pisani, executive director of the Idaho Council on Developmental Disabilities, has warned that provisions transitioning to a managed-care system and another hastily repealing existing regulations will cause “utter chaos” for those who rely on home and community-based services.

(Paradoxically, home and community-based services include things like occupational therapy, which are essential for many disabled people to work and earn a living.)

It’s also mistaken to think that costs will be contained by kicking people off Medicaid. If you have a broken leg and no health coverage, you will go to the emergency room, where the hospital will treat it. Then you will get a bill you can’t pay. Meanwhile, the hospital has to cover those costs somehow.

Absent payments from Medicaid, it can only charge more for insured patients. And insurance companies will, in turn, recoup their costs through your monthly insurance premiums.

So the choice facing the insured isn’t whether to pay for the uninsured or not. It’s whether to pay through taxes or through insurance premiums. For the common Idaho family, taxes are obviously the preferable option.

First, Medicaid is mostly covered by federal taxes, and since the median family in Idaho makes around 10% less than the median family nationwide, Idaho shoulders a relatively smaller portion of the cost burden than do other states.

Second, Medicaid is paid for mostly through a progressive income tax, in which the wealthy pay more and lower-income families pay less. That’s not how health insurance premiums work.

What’s most important is that the federal government pays 90% of the costs of Medicaid expansion, and most of the costs of traditional Medicaid. For every person on Medicaid, Idaho taxpayers cover only 10% of the cost. For every person with no coverage, Idaho insurance premium payers pay 100% of the cost.

So it’s time for Little to show that the office of governor isn’t ceremonial. Earlier in his term, Little vetoed as many as six bills in a legislative session. This year, he has vetoed none, and signed some bad ones after “voicing concerns.”

It’s time to take out that veto pen and make sure it still works.