As special interests again begin to beat the Medicaid expansion drums in the run-up to the 2018 legislative session, be assured that your Idaho Legislature decided wisely in turning down Medicaid expansion.
Medicaid expansion, an option under the so-called Affordable Care Act, has a record of understating costs in nearly every state that chose to broaden the program. We need only look one state to the west to examine expansion’s real impact.
Oregon expanded Medicaid to childless, able-bodied adults in 2014 under then-Gov. John Kitzhaber. Since then, more than 350,000 Oregonians have joined the program, which progressive pundits and politicos call a major success.
Then, as it always does, financial reality set in. This year, the federal government began scaling back how much it pays for the expansion population, originally 100 percent. Thanks in part to that expansion, Oregon lawmakers opened their 2017 session facing a $1.6 billion shortfall.
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Early in negotiations, Democratic leaders seriously considered dismantling expansion to balance the state’s books. They eventually caved, and raised taxes by about $550 million.
Thanks to the Gem State Legislature wisely resisting the allure of free federal cash, Idaho need not choose between yanking coverage from tens of thousands of residents or raising taxes on middle-class families.
A growing number of the most vulnerable Idahoans, more than 300,000 kids, pregnant women and disabled residents, rely on Medicaid to meet their health needs. Expansion would threaten care for these populations, thanks to a perverse incentive written into the health law.
By 2020, the federal government will cover 90 percent of costs to cover enrollees in the expansion population, compared with the 70 percent Uncle Sam pitches in to pay for the traditional population. Thus, were Idaho to expand and eventually face weak tax revenues in an economic downturn, lawmakers would have an incentive to cut care for the traditional populations, which cost the state more. So, why can’t the federal government fund all of Medicaid at 90 or even 100 percent? Well, in case you hadn’t noticed, Uncle Sam is nearly $20 trillion in debt and Medicaid is an increasingly large driver of the seemingly permanent federal deficits.
Beyond that, Medicaid expansion would likely gobble up any extra state budget dollars lawmakers would otherwise dedicate to other critical programs. Pay teachers more? Nope. Invest in road and bridge repair? Nah. Deliver significant tax relief to middle-class families and small businesses? Forget it if you expand Medicaid in Idaho.
There is a way to bring down the cost of insurance, but such a move would require courage from Idaho’s insurance carriers, plus elected officials and candidates for office.
A key component of the ACA forces everyone to buy health plans with 10 essential benefits. These benefits are required by the federal government but are not necessarily desired by consumers.
To be bold, the carriers should craft consumer-driven insurance plans that offer benefits that Idahoans want. For example, if a single male wants to purchase a plan that doesn’t offer maternity coverage, he should be able to buy it in the Idaho market.
The Idaho Department of Insurance’s July 31 news release promoted the idea of insurance carriers selling consumer-driven plans — which are noncompliant with the ACA. It’s unlikely President Donald Trump’s U.S. Department of Health and Human services would punish insurance carriers for offering what consumers want, even if it means ignoring a ridiculous and onerous Obamacare mandate.
According to the Idaho Department of Insurance’s own estimate, allowing Idahoans to purchase tailor-made plans would drop premiums between 20 and 50 percent.
Now that would be a great start toward affordable health care.
Fred Birnbaum is vice president of the Idaho Freedom Foundation.