The Affordable Care Act, signed into law on March 23, 2010, sought to expand health coverage using a three-prong approach: expanding Medicaid to cover the poorest members of society (those falling 138 percent below the federal poverty line); providing health insurance subsidies for those with low to medium incomes (100-400 percent of the federal poverty line) who lacked access to employer-sponsored health plans; and mandating that all individuals have health insurance.
Republican Gov. Butch Otter rejected the Medicaid expansion in 2013 and again in 2014. Idaho stood to receive more than $7 billion in federal assistance to cover health care costs for the more than 78,000 adults who currently do not qualify for Medicaid or for subsidized private insurance, often referred to as the “working poor.”
With budget shortfalls and increasing Medicaid enrollment, the Idaho Legislature has sought to curb spending on the backs of the poor. Richard Armstrong, director for the Idaho Department of Health and Welfare, has publicly acknowledged that Idaho ranks close to last in the nation for median household income. Idaho’s economy is slowly recovering from the housing market recession. However, decreasing Medicaid budgets, declination of federal funding to expand Medicaid and continuance of low wages are contributing to Idaho citizens literally dying from being poor.
Beginning in 2014 under the Affordable Care Act, the federal government would fund Medicaid expansion at 100 percent, and in 2020 that funding would decline to 90 percent. Opponents of the expansion worry that states “would be on the hook if federal funds one day dry up.” House Speaker Scott Bedke acknowledged strong opposition to Medicaid expansion within his caucus. State Rep. Fred Wood, chairman of the Health and Welfare Committee, stated “Idaho is never going to go down the road to expanding an entitlement program,” citing increased costs to Idaho and more intrusion of the federal government.
Contrary to the Idaho Republican Party’s erroneous belief, the expansion of Medicaid actually saves states large amounts of money within the first year of expansion. A report generated by the Robert Wood Johnson Foundation placed realized savings into three categories: state savings from using federal funds, state savings by using enhanced federal funds, and revenue gains. Arkansas and Kentucky are examples of how Medicaid expansion can save states money and provide increased revenue. Projecting forward, these state initiatives will exceed program expansion costs, fund Medicaid at least through fiscal year 2021, decrease the number of uninsured and increase coverage for the working poor.
Panel members testifying in front of the House and Senate Welfare committees concluded that Idaho would save an estimated $173 million over what it would spend using existing state and county indigent care programs, in addition to receiving more than $7 billion in federal financial assistance through 2025 for Medicaid expansion.
House Minority Leader John Rusche and Rep. Dan Schmidt, two Democrats and physicians, lobbied for Medicaid expansion during the last legislative session. “The financial case (for expansion) is undeniable .…What really gets me is the fact that uninsured people have shorter lives, they have work history that is interrupted by illness, and an increase in death,” Rusche said.
However, as another year is inching to a close, Republican lawmakers continue to refuse to expand the program, wasting money and turning their backs on the working poor.
Nicole Sorensen, of Twin Falls, is an assistant professor at the College of Southern Idaho. She has been a registered nurse for 16 years and a nurse practitioner for five.