Good public policy is and must be shaped by a conceptual framework that relies on a discipline such as economics or political science, solid data and reliable research methods. Public policy about providing access to health care is not an exception. In addition, our choices as a state should strive to ensure we get the highest return for our public dollar invested.
Key data on the coverage gap was introduced during a recent meeting of the legislative work group tasked with finding a solution for the gap population. In August, Close the Gap Idaho, a group trying to reduce the number of uninsured Idahoans, introduced its “Understanding the Coverage Gap In Idaho,” a book that uses hard data to show how our current situation is failing our state, and how a coverage gap solution could benefit us all. Developed by Idaho Voices for Children and the Idaho Center for Fiscal Policy, it delivers key data on the coverage gap. Members of the working group, other lawmakers and the public would do well to let the data inform any solution that comes out of the working group.
The data are clear. Despite the fact that many Idahoans can’t afford health insurance, fewer people in Idaho are eligible for Medicaid than in other states. Adults in Idaho must make less than $289 per month with one child to receive care through Medicaid.
What does the uninsured population in Idaho look like? The majority are working. They are our friends and neighbors, working in restaurants, child care, agriculture or other jobs where wages are low and work might be seasonal. It might surprise you to know that Idaho has the highest rate of uninsured veterans per capita in the nation.
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Our current health care delivery system isn’t set up to help these people and those small businesses that they work for in a cost-effective manner, but it could be if we closed the coverage gap. Today, a family of four must make less than $6,318 annually in order to qualify for Medicaid and more than $24,300 annually to qualify for a tax credit to buy insurance through the state health care exchange. This leaves an estimated 78,000 Idahoans without the ability to see a doctor or pay for a hospital bill.
Local taxes currently subsidize medical bills for those who can’t afford care. State taxpayers pick up the bill for anything over $11,000 per case. In 2015, Idaho paid $36 million to cover the medical costs for only 3,795 people. If Idaho closes the coverage gap, an investment of about $45 million in the first year of implementation would provide health insurance for over 115,000 Idahoans.
Over five years, a preferred time frame by budget analysts for examining the impact of a policy, it is estimated that Idaho will see a net savings of $165.5 million, including new revenue generated from the return of our federal taxpayer dollars. Longer-term projections show that the fiscal benefits of closing the gap persists each year, even as far as 10 years out, and these long-term projections indicate that the fiscal benefits of closing the gap will continue.
The data and careful analysis show that one of the most significant things we could do as a state to improve our local economy would be to close Idaho’s coverage gap. Finding a solution to the health care coverage gap in Idaho, that boosts the health and economic well-being of the state, should be paramount to all members of the working group.
Professor Zeynep K. Hansen is the chair of Department of Economics at Boise State University and a research associate at the National Bureau of Economic Research. She is a graduate of Boise State University.