Medicaid expansion is a success story, no matter how detractors want to spin the tale

Anyone who says Idaho’s Medicaid expansion hasn’t paid dividends hasn’t looked at the humanitarian, medical or financial ledgers.

That isn’t stopping acolytes of the Idaho Freedom Foundation, which fought tooth and nail to prevent the 2018 Medicaid expansion voter initiative from prevailing. As the Lewiston Tribune’s William L. Spence noted last month, the Legislature’s reluctant implementation of that initiative included an escape clause: By Jan. 31, lawmakers on the House and Senate health and welfare committees shall “review all fiscal, health and other impacts of Medicaid expansion ... (and) make a recommendation to the Legislature as to whether such expansion should remain in effect.”

The Freedom Foundation gained legislative seats in last spring’s GOP primary election. So it may have the clout to attempt repealing Medicaid expansion next winter.

What’s got them worked up is the fact that 130,675 Idahoans are entitled to Medicaid coverage — meaning they made too little money to qualify for government-subsidized private health insurance under Obamacare but made too much for traditional Medicaid benefits. The federal government’s response to the COVID-19 pandemic artificially raised some of those numbers, but it is more than double the estimated Medicaid gap population at the time of passage.

Why is that bad news?

It should be no surprise that Idaho is a poor state.

And the more poor people who get care under Medicaid, the better for them, the people who care for them and everyone else who either pays taxes or health insurance premiums.

For instance:

• A woman no longer has to delay a hip replacement until she reaches age 65 and qualifies for Medicare. Delay typically means inactivity, gaining weight, risking the onset of diabetes and, of course, forgoing employment.
• A man can seek bypass surgery for his coronary artery disease. To languish without that treatment could lead to a heart attack and a costly stay in the hospital, at best.
• The type 2 diabetic can seek aid, thereby preventing vascular disease as well as a disabling foot or hand amputation.
• A patient gets timely treatment for pneumonia, which means avoiding septic shock and with it, a four-fold risk of mortality — not to mention an expensive stay in the intensive care unit.
• An individual gets diagnosed and medication for high blood pressure, thereby preventing a stroke that could result in long-term disability and costly ongoing rehabilitation services.

Since the federal government covers roughly 90% of the costs, the state’s share comes to about $58 million — again, more than expected.

First, however, deduct some of the bills the state no longer pays due to Medicaid expansion.

Among the offsets is $10 million the state no longer has to funnel to its public health districts.

Add to that about $21 million the state no longer allocates to its Catastrophic Health Care program.

Next comes the benefits of infusing Idaho’s economy with $840 million in federal Medicaid spending. A preliminary University of Idaho study says that money will generate about $36 million in new sales and income taxes — more than enough to cover Idaho’s investment.

Either way, it’s a rounding error in a state budget that has also grown from $3.45 billion four years ago when Medicaid expansion was approved to $4.26 billion today — or 6% annually.

For every $1 in new Medicaid spending, the state’s economy grows by $1.80.

What an incredible bargain.

Finally, there’s the human factor. More than half of Idaho’s Medicaid gap population is employed. At least some of them are working — and paying taxes — because Medicaid allowed them to get healthy.

By any measure, this is a success story.

To regress — as the IFF and some conservative lawmakers no doubt would prefer — will cost lives, return many Idahoans to a level of suffering we sought to eliminate and leave everyone who pays taxes or health insurance premiums holding the bag.

Who in their right mind would do that? — M.T.