Guest Opinions

Saving money is not the best, or only, reason to offer more people Medicaid coverage

Trevor Buffi, Nampa, signs a petition for a Medicaid expansion initiative after meeting volunteer Laurie Durocher at the door in April.
Trevor Buffi, Nampa, signs a petition for a Medicaid expansion initiative after meeting volunteer Laurie Durocher at the door in April. doswald@idahostatesman.com

Much of the debate around Medicaid expansion centers on its financial impact, good or bad.

In fact, the Idaho Statesman recently published an article explaining how we already pay for some of the medical care received by uninsured Idaho residents, and how Medicaid expansion could reduce those costs.

In that same piece, Sven Berg explains that the state has requested an updated fiscal analysis, due out in June, to help clarify how expansion would affect state and local budgets. Some previous estimates performed by the state and others have predicted that Idaho will save money overall by expanding Medicaid — this has certainly happened in other states.

But while it is important to weigh the financial impacts of expanding Medicaid eligibility, money isn’t the only measuring stick Idaho should use. Too much of a focus on finances could lead some to suggest that expansion would be worthwhile only if it ends up saving the state money.

That just isn’t the case.

As a Medicaid researcher and physician-in-training, I know that Medicaid offers real benefits to the people who rely on it — and those benefits don’t usually show up in budgetary analyses.

Even if Idaho has to spend more than it saves to expand Medicaid, it’s a worthwhile investment. There is plenty of evidence on how it helps its beneficiaries, drawn from states that have already chosen to expand. Some of the highest quality research comes from the Oregon Health Insurance Experiment, which found that after enrolling in Medicaid, recipients spent less money out-of-pocket on health care and had virtually no catastrophic health expenditures. Rates of depression went down and self-reported measures of health got better.

Other work suggests that Medicaid can improve credit scores, lead to earlier diagnosis of cancer, boost children’s future earnings, improve access to medical care for people with chronic diseases — and yes, even save lives.

Beyond these things, Medicaid offers help and hope to the most vulnerable in our state. It can change the lives of those who rely on it. Medicaid expansion would offer coverage to 62,000 people working hard to care for their families, but who lack access to another option for affordable health coverage. I would suspect that most Idahoans have either counted on Medicaid or know someone who has — I certainly do.

We also know neighbors, family, and friends who Medicaid would help, should expansion pass this fall. These are real people in our state, not just numbers on a spreadsheet.

Our state rightly chooses to spend money on things that don’t save money, whether that’s building public parks or funding police departments. These programs offer real benefits that the state doesn’t overlook in deciding whether to fund them, even when they show up in the lives of Idahoans rather than in a state balance book. We shouldn’t hold Medicaid to a different standard.

Daniel Nelson is from Nampa and is studying medicine at the University of Michigan and public policy at Harvard University. He helps direct policy and health care community outreach at Medicaid for Idaho, an organization seeking to expand Medicaid eligibility through a statewide ballot initiative.

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