The impact of Medicaid expansion in Idaho: Lives saved and health care improved | Opinion

Once again in Idaho we find ourselves at a decision point, as we faced before, whether we will agree that basic healthcare — lifesaving, life-sustaining healthcare — should be a basic feature extended to all citizens, to all our neighbors and to all our community, regardless of their financial standing in life. The decision we made as a state previously, that healthcare was deserved by all Idahoans, is under serious attack in the Legislature.

We made that decision in 2018, after a quirk in the Affordable Care Act and a Supreme Court decision allowed states to deny coverage to individuals below 138% of poverty level. After many in our state were left in that “gap”, and after watching the devastating effect that lack of healthcare had on our citizenry, we took action. As a practicing critical care physician then I watched as our poorer citizens — hard-working, financially struggling families — delayed medical care until their diseases were imminently life-threatening, when they had no choice but to receive emergency care, when their prospects for survival were greatly diminished.

And many died.

Based on reliable calculations on the effect of lack of healthcare on just survival — to say nothing of the effect on quality of life and ability to work and thrive, we estimated that at least one Idahoan per day died directly as a result of being in the “gap.”

I was “gaveled” and threatened with contempt in testimony to the Legislature for suggesting that the Legislature was responsible for those deaths by refusing to extend Medicaid.

The vast majority of Idahoans saw the truth. After much work by a wide cross-section of citizens, banging on doors, talking to neighbors, by a 61% majority, expansion of Medicaid was passed in an initiative, a remarkable feat in our conservative state where we value our independence and self-reliance, but where we also value taking care of each other when needed, and where we recognize that depriving any of our citizens of healthcare is simply cruel and inhumane.

And we continue to recognize the importance of continuing to provide this healthcare. In 2023, a poll showed that support for Medicaid expansion had increased to 73% of those surveyed, and that included 65% of Republicans, as well as the vast majority of Democrats. For us, as Idahoans, this is not a partisan issue, but rather a matter of taking care of our neighbors, our families and our communities. Medicaid expansion now provides care to 145,000 Idahoans — 13.5% of our population according to an Idaho Department of Health and Welfare 2023 report — and all of Idahoans know someone — a family member, a neighbor, a work-mate, who can now receive dignified, continuous healthcare as a result of Medicaid.

Practicing now in an outpatient setting, and teaching, I witness daily the results of those efforts. My young resident physicians do not understand the difference in care patients can receive now as a result of having coverage. No longer do patients delay care for their chronic diseases until they have a life-threatening emergency. No longer do patients with asthma delay care because they cannot afford to go to the emergency room and have no other source of care. They can now seek care in an office setting — at phenomenal cost savings and when their disease exacerbation can be managed simply, as an outpatient.

One of the most tragic losses of life I experienced before expansion continues to haunt me, an entirely preventable death of a young woman who had no access to care until she arrested and was brought to the ER.

I have difficulty describing the difference in care for our lower-income patients now compared to pre-expansion. Now patients can receive ongoing care for their chronic diseases, for their diabetes and heart disease and their debilitating arthritis and lung disease and multiple other disease states, and can be treated while the process can be contained, and thus they can continue to work and care for their families (as is the case for over 80% of Medicaid recipients).

I witness this transformation daily, and while my young residents do not comprehend the magnitude of the difference in patient care from before Medicaid expansion to the present, they can care for our poorer citizens knowing those patients are receiving the same care as all other patients, that we have eliminated a “class” of our citizenry who are unable to receive the same quality of care as the rest of our population, that income no longer determines who gets care and who doesn’t.

It’s been an almost indescribable transformation in healthcare. And it’s also cost-effective. But beyond the economics, it’s the most humane, neighborly, decent demonstration of our caring for each other we can provide.

Don’t let the Legislature take that away.

A bill to entirely repeal Medicaid has recently been withdrawn after public outcry, but other attempts will be made this legislative session, likely involving a bill similar to one introduced last session that would require numerous federal exemptions for Medicaid to continue. Bill sponsors cynically know those exemptions will not be approved, thus ending Medicaid in the state.

Ending Medicaid will cost lives and impair the health and well-being of over 100,000 Idahoans, impacting us all, affecting our families, our neighbors, our communities The cost cannot simply be expressed in economic terms. Help prevent this travesty. Get involved.