Guest Opinions

Honestly, it’s time to close the Medicaid gap

Chief Justice John Roberts wrote in the Affordable Care Act decision in 2014:

“We look to the States to defend their prerogatives by adopting the simple expedient of not yielding to federal blandishments when they do not want to embrace federal policies as their own.”


1. A flattering or pleasing statement or action used to persuade someone gently to do something.

Idaho gets federal matching money for state programs all the time. And, of course, federal requirements come with them. About a third of the total Idaho budget is federal dollars.

I have been working for years to get my legislative colleagues to consider the proposition to change Medicaid eligibility, so 78,000 working, poor Idahoans could get health insurance coverage. There has been little legislative interest in this solution; I struggle to understand why. I learned something from a colleague last session.

We have seen CAT fund costs go down from strong enrollment on the exchange. Thank you, Gov.Butch Otter. But folks making less than 100 percent poverty level aren’t eligible for the exchange. This is “the gap.” Making Medicaid open to them would mean we would be accepting federal rules if we took that federal money. Thirty-one states have taken this step. We should, but Idaho hasn’t.

Here‘s why.

At an event last session, I was milling around and ran into a conservative colleague. We share an interest in developing rural broadband access, and he had just learned of a federally supported program that would build out fiber to underserved areas at a 10:1 match. If Idaho invested $5 million, the feds would dump in $50 million. He was ecstatic to learn about this. I shared his enthusiasm. We need rural broadband in this state.

Then I pointed out, we could get rid of the CAT fund and improve Idaho health care funding and save Idaho taxpayers with an even higher match rate (20:1).

He frowned. He knew what I was referring to. “Oh, there you go again with that liberal Obamacare stuff. We can’t take that money because the feds are bankrupt.”

“Just a minute,” I caught his gaze and said honestly, “you just enthusiastically endorsed accepting federal money for broadband development, but refuse it for health care. Can you explain to me how you make this distinction? I want to know.”

“That Medicaid expansion is never gonna happen, not here in Idaho, you gotta know that.” He was trying to laugh me off.

I kept my gaze on him; I even touched his arm. “Look, I really just want to know how you make this decision. How do you decide when is it OK to take federal money, and when isn’t it?”

He looked away but I could tell he was considering. He honored me with an honest reply.

“I guess I just decide based on what’s important to me.”

I thanked him for his honesty.

Improving the health, the well-being, the prosperity of Idaho is very important to me. I believe covering this “gap” population with a health insurance plan would serve us all.

Dan J. Schmidt, of Moscow, is a state senator for District 5 and a physician.