Idaho GOP lawmakers threaten Medicaid with claim that spending is out of control | Opinion
Last week, the House Health and Welfare Committee voted to introduce a bill to repeal Medicaid expansion, as Ian Max Stevenson reported, which Idaho voters overwhelmingly approved in 2018 after years of dithering and inaction by lawmakers.
Medicaid expansion granted coverage to the working poor — people who made a bit too much to qualify for traditional Medicaid, but not enough to qualify for subsidies to purchase insurance from the state exchange.
The bill is sponsored by Rep. John Vander Woude, R-Nampa, the committee chairman and one of the original lawmakers who failed to fix the Medicaid gap for all those many years.
Vander Woude relied on a tired argument you’re likely hear a lot of this session: that Medicaid expansion was wildly more expensive than anticipated, that Medicaid spending is out of control.
None of that is true.
As I documented previously, Medicaid spending is nowhere near out of control. Combine the effects of inflation and population growth, and you would expect spending on any entitlement to grow around 42% since 2019. Medicaid spending has grown around 48%, a bit faster, but not much faster than you would expect. Much of that is probably because the cost of medical care continues to rise faster than the prices of other goods and services.
And net spending on Medicaid expansion is far lower than that topline number. Before expansion, when people were uninsured and had medical bills they couldn’t cover, county and state taxpayers picked up the balance through catastrophic and indigent funds. Many of those costs have shifted onto the Medicaid bill, which just changes how they’re paid for, not how much they cost.
And there’s almost certainly some amount of cost savings that are building up through preventative care. It costs a lot less to start treating someone’s high cholesterol at 40 with generic drugs than it does to treat them for a heart attack at 50. It’s hard to measure these kinds of savings, but they’re certainly significant and grow over time. So we’re paying less now so we don’t pay more later.
Those are just the costs the program directly offsets. But when the government spends money (and for every dollar Idahoans pay for Medicaid expansion, the feds send $9) that money circulates and spurs economic growth, just as if an individual or business were doing the spending. As Rep. Ilana Rubel, D-Boise, rightly noted, cutting off Medicaid expansion would amount to “sucking a billion dollars out of our economy.”
And lawmakers can’t use the excuse that Idaho is short on funds. At the same time the GOP is threatening to overrule the will of the people and revoke Medicaid expansion, lawmakers hope to spend hundreds of millions on tax cuts and private school vouchers.
All of these should put to rest the financial case for ending Medicaid expansion. But the finances are far from the most important thing.
And then, of course, there are the things that really matter, the things that aren’t a matter of dollars and cents. There are the hundreds of Idahoans who died, according to the estimates of Dr. Ken Krell, due to lack of access to health care while the Legislature failed to expand Medicaid. People like Jenny Steinke who, as the Post Register reported in 2015, died an agonizing death of asthma because she couldn’t get simple medication to treat her.
Contrary to the assertion of our attorney general, people do die because they lack access to health care. Hundreds of our neighbors died before we forced the state to expand Medicaid, and hundreds will start dying again if Vander Woude’s bill becomes law.
Is that the world these lawmakers want to return to, people dying of asthma and other preventable and treatable conditions? Opponents of the Affordable Care Act liked to falsely claim that it was going to lead to government death panels. The only contender for that title I see is the House Health and Welfare Committee.
This story was originally published January 28, 2025 at 4:00 AM.
CORRECTION: This story has been updated to correct the year Medicaid expansion passed.