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Shawn Vestal: Analysis shows why expanded Medicaid coverage in Idaho makes sense for everyone

August 8, 2018

As the campaign to expand Medicaid in Idaho rolls on, despite the best efforts of the politicians to stop it, opponents have adopted a couple of tried-and-true tactics.

First: Simply repeat the word “Obamacare” as often as possible, to gin up still-simmering hostility toward the former president. Second: Suggest that Medicaid expansion will be adding a bunch of lazy non-working adults to the government teat, trapping them in a life of dependency.

Free stuff for moochers, you know.

Opposition to Medicaid expansion doesn’t get much deeper or smarter than that, and it might not need to, unfortunately. But if enough Idaho voters tune in to the emerging facts, what they’ll find is that expanding Medicaid would be good for tens of thousands of uninsured Idaho residents – and it would be good for the rest of Idahoans, too, because it would do so at bargain prices.

Depending on how the state restructured its own programs after an expansion, it could even save millions in state and local tax dollars – money that could be applied to schools or streets or cops or, heck, per-diems for legislators living it up in Boise during the session.

Yes, it’s possible – given a large number of variables and unknowns – that Idaho could save money while helping its uninsured citizens.

That’s the takeaway from an actuarial analysis commissioned by the state. Expanding Medicaid would shrink Idaho health care spending. It wouldn’t eliminate it, but it would likely be the most efficient way to close the gap that leaves between 51,000 and 62,000 people without insurance in the state.

Expansion would spend mostly federal money on the front end and save state and local tax money on the back end, by reducing unpaid hospital care. It might allow the state and counties to eliminate programs that cover unpaid health care for people who show up at the hospital without insurance or the means to pay, and if it did so, the savings would outpace the costs, according to the actuarial analysis.

The report, prepared by Milliman Inc. for the Idaho Department of Health and Welfare, estimates that if Idaho expanded Medicaid coverage and eliminated the indigent and catastrophic care programs run by the state and counties, it would save $15.6 million in state and local budgets between 2020 and 2030.

If those programs were kept in place even with reduced need, the impact on state and local governments would be a net increase of $4.4 million over that decade – a cost of less than $50 per person covered each year, the Idaho Center for Fiscal Policy estimates.

You might think it sounds like a no-brainer. But no-brainer is a better description for the intense resistance that Idaho has shown to closing the so-called Medicaid gap. People in the gap earn too much to qualify for Medicaid and too little to qualify for insurance subsidies; the Affordable Care Act offered states the chance to expand Medicaid eligibility from 133 percent of the poverty level to 138 percent to include those people, with the federal government picking up 90 percent of the cost.

Thirty-three states have expanded Medicaid. Eighteen have not. Idaho has empaneled commissions and held debates and wrestled over legislative proposals including so-called Ottercare – and done nothing. Idaho voters will have the chance in November to succeed where lawmakers have failed when they consider a ballot initiative to expand Medicaid.

Now, it may be that you consider these financial analyses beside the point. It may be that you’re thinking more of those people in the gap and how having health insurance might improve their lives. It’s clear that people in Medicaid-expansion states like Washington have more access to health care. But there are also studies that drill down into that access more specifically, and suggest that expansion helps head off catastrophic health problems earlier.

A detailed Kaiser Family Foundation review of scientific research cites study after study showing improvements in early diagnoses rates and overall quality of care associated with Medicaid expansion. The reviewed literature is not all positive by any means – the expected drop in emergency room usage that supporters of expansion repeatedly predicted hasn’t materialized – but in terms of access and quality of care, virtually all of it is.

One might think such evidence would be argument enough. If it isn’t, though, Idahoans can also consider the bottom line.

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