Sideboards on Medicaid? What these Idaho lawmakers really mean is a flood of red tape | Opinion
With the Legislature’s tilt to the right this year, few issues will be of higher consequence in the coming legislative session than Medicaid expansion, which Idaho voters overwhelmingly approved in 2018 after years of inaction by lawmakers.
The program has meant that well over 100,000 Idahoans are no longer in the Medicaid gap, making too much to qualify for traditional Medicaid but not enough to qualify for subsidies under the Affordable Care Act.
The budget for the program has grown significantly since it was passed, and it should be carefully monitored. But there’s a brewing false narrative that Medicaid expansion is out of control, is being widely abused or is wasteful. Those are all falsehoods, excuses intended to provide lawmakers with justification for significant cuts in the program.
Medicaid is not out of control
The Medicaid budget has grown significantly, but not as much as some of the rhetoric from lawmakers might have you think. Between fiscal years 2019 (the year before expansion was implemented) and 2023, the state’s actual spending on Medicaid from the general and dedicated funds grew from $840 million to $1.24 billion.
That sounds like a lot of money, but let’s put it in context.
First, as everyone knows, we went through a round of significant inflation, so a dollar today isn’t worth as much as a dollar in 2019. Measured by personal consumption expenditures, there was about 30% cumulative inflation over the period in question. (It’s also worth noting that the cost of all medical care in general continues to rise in price faster than the general rate of inflation, a problem that has been ongoing for decades and remains unsolved.)
Second, as everyone also knows, Idaho’s population has exploded in recent years. That means pretty automatic increases in both tax receipts and total spending. Idaho’s population grew by a cumulative 9% over the period in question.
Take both of those into account, and you’d expect the budget of just about any guaranteed benefit program in Idaho to grow by about 42% if you did nothing. State spending on Medicaid has grown by about 48% — a bit faster, but not a lot faster — while covering an entirely new set of people.
That extra bit of growth is not crushing you with taxes. It amounts to a difference of less than $30 per year for the average Idahoan. That’s the extra bit you’re kicking in to keep tens of thousands of your neighbors from going without health insurance, from going into bankruptcy if they face an illness or an injury. That’s a pretty good deal.
Most sideboards are really just cuts
The most common ideas for so-called “sideboards” — as the Legislature generally calls measures meant to keep programs from having unintended consequences — are all really just cuts in disguise.
The most obvious is work requirements, an idea Rep. Jordan Redman, R-Coeur d’Alene, raised in a recent interview with the Idaho Capital Sun.
What’s wrong with a work requirement if nearly everyone covered by Medicaid expansion is already working? The big problem with a work requirement is the red tape. It’s one thing to work, it’s another thing to prove to a government agency that you’re working.
What if you’re working day labor jobs, or working in jobs where work comes in spurts? What if you’re going through a period of homelessness despite working and are unable to easily access the internet? What if you’re intermittently employed while also providing care for a relative? What if your grasp of English isn’t perfect, making complicated paperwork impossible to navigate?
In all these cases, you probably get kicked out of the program despite meeting all the requirements. So what winds up happening any time you put in place work requirements is that tons of working people lose access to benefits they actually qualify for.
A 2019 study in the New England Journal of Medicine of the work requirements passed by Arkansas found that of the tens of thousands of residents kicked off the Medicaid rolls following passage of its work requirement, more than 95% were, in fact, eligible for benefits. They were generally working but unable to do the paperwork. This is a consistent pattern across a wide range of programs when paperwork-intensive requirements are added.
So when following the upcoming legislative session, be very wary of anyone telling you they’re ready to put “sideboards” on Medicaid expansion. Let’s call it what those lawmakers would call it if the federal government did it: tying up hard-working Idahoans in a mess of red tape.