As the Trump administration works to undermine key provisions the Affordable Care Act, one substantial part of the ACA has proven resilient: The Medicaid expansion.
During the past 10 months, there have been four failed attempts to repeal Medicaid expansion, a program that extends Medicaid coverage to adults up to 138% of the federal poverty level. Repeal of Medicaid expansion would have ended coverage for millions of Americans in the 31 states that have already expanded Medicaid. For Idaho and 18 other states that have not yet expanded, such a repeal would have killed any future opportunity to expand Medicaid using federal dollars.
It appears that Medicaid expansion is here to stay. Considering this, we have an unprecedented opportunity here in Idaho to move forward and build the health-care system that Idaho deserves. Now is the time for a statewide ballot initiative to expand Idaho’s Medicaid program.
The time is ripe to give voters a choice to extend affordable health care to 78,000 Idahoans who fall into the “Medicaid gap” — those who earn too much money to qualify for Medicaid but not enough to afford insurance on the state health care exchange.
Our state lawmakers have balked at the idea of Medicaid expansion, but the vast majority of Idaho voters say they are disappointed with the failure of the Idaho Legislature to address the Medicaid issue. A recent Boise State survey found that 70 percent of Idahoans favor legislative action to close the Medicaid gap.
Idaho is among just 19 states that have not expanded Medicaid. In these states, far right-wing lobbyists and politicians have branded Medicaid expansion as a partisan issue. In fact, expansion has enjoyed substantial support from voters and legislators in both parties. Eleven states led by Republicans have expanded Medicaid.
Several Republican governors, including Brian Sandoval of Nevada, Rick Snyder of Michigan and John Kasich of Ohio, have championed Medicaid expansion as a pragmatic way to provide health insurance to the thousands of working families who lacked access. Speaking of the 700,000 who benefited in Ohio, Kasich said: “If they don’t get coverage, they end up in the emergency room, they end up sicker, more expensive. I mean, we pay one way or the other.”
Last July, I joined with a team of committed Idahoans to launch a nonpartisan statewide tour to advocate for the expansion of Medicaid. We painted a 1977 Dodge camper bright green, labeled both sides with “Medicaid for Idaho” and visited communities in every corner of the state.
We made a special effort to visit rural, conservative-leaning communities where, we were told, no one would sympathize with our message. In every community we visited, we found overwhelming support. We heard heart-wrenching stories: young single mothers working two and three jobs to cover medical bills of relatives while also trying to raise children; cashiers and cooks who fell into the Medicaid gap as soon as they found employment; people who will leave this state that they love, and who will leave family behind, simply because they can’t find affordable health care in Idaho.
Our campaign is looking to the future. We have decided to launch a petition campaign to put Medicaid expansion on the ballot in November 2018.
Of course, there will be skeptics. Even some who believe in the cause of affordable health care will point to a new proposal to address the Medicaid gap called the Idaho Health Care Plan, recently proposed to the governor by the Department of Health and Welfare. Proponents might object to a full-fledged expansion campaign on the grounds that such a campaign could interfere with efforts to pass a more modest proposal.
Our campaign will not obstruct the effort to pass the Idaho Health Care Plan. Instead, an initiative campaign will awaken voters to the urgency of the crisis and bring the issue to the forefront of the conversation. It will press lawmakers to act now rather than again kicking the can down the road.
If the Idaho Health Care Plan suffers the same fate as its predecessors, voters will get a chance to decide in November 2018.
Any Idaho initiative must gather signatures from 6 percent of all registered voters statewide and also from 6 percent of voters in 18 different districts. That means a campaign cannot simply build support in population centers like Boise, but must organize and build support across the state.
This is exactly the challenge we need. If we are going to change the conversation and achieve the health care system we deserve, we have no choice but to build a statewide grass-roots movement.
We can win. When we toured the state and talked to Idahoans from all walks of life, one thing became clear: There is a sleeping giant in this state. Its head is in the Panhandle. Its limbs stretch down to Salmon and Shelley, Blackfoot and Burley, McCall and Mountain Home. Its heart is everywhere. It has no political party, because it is bigger than the parties.
It yearns for health care and economic security for all. It dreams of a day when no one goes bankrupt just because they get sick. If the sleeping giant is not being heard, it is only because it is asleep. A ballot initiative campaign would awaken it.
Luke Mayville, a Sandpoint native and co-founder of Reclaim Idaho, teaches civics and western civilization at Columbia University.