Birnbaum to lawmakers: Encourage charity care rather than expanding Medicaid

Fred Birnbaum, vice president of the Idaho Freedom Foundation, told lawmakers this morning, “You’ve heard from other presenters that the data from other states is good, that Medicaid expansion has benefited them economically. But there’s a problem with that.” He noted that Medicaid expansion is funded 100 percent by the federal government for the initial period, then it phases down to a 90 percent to 10 percent federal-state match. “We have no data yet where the state has to pay a portion of the expansion costs,” Birnbaum said.  “We don’t have it because it hasn’t come to be.”

He warned of a “perfect storm,” saying costs could skyrocket, particularly if that match fell precipitously in the future, though the law says it would stay at 90-10. “Some people said we’re sending dollars to Washington, we should get them back – that’s true, we all pay taxes,” Birnbaum said. But, he said, “Medicaid expansion is all borrowed money … so current taxes aren’t covering current spending, so if you put more spending onto that deficit I don‘t think you can say our taxes are paying for it, somebody’s will eventually.”

Birnbaum said his group also doesn’t like the idea of waivers, in which Idaho would seek permission from the federal government to tap expansion funds to design its own program for the gap population, departing from the standard Medicaid model. “The waiver doesn’t eliminate the issue of dependence on the federal government. … Waivers aren’t forever and they don’t resolve the issue of federal dependency,” he said.

“I’ll acknowledge at the opening that when you look at our solutions, that if you push the Medicaid expansion button it seems like a comprehensive solution, and what we’re offering is more piecemeal,” Birnbaum said. “Medicaid expansion is a comprehensive program, but if it’s not an economically sustainable solution it’s not a solution. What we’re proposing is a number of things that would encourage private charities that exist now.”

Sen. Steven Thayn, R-Emmett, said he fears the 78,000 figure could be low, and twice as many people could enroll, as happened in some other states. But Rep. John VanderWoude, R-Nampa, said, “We’re told that’s a solid number,” because Idaho has experience based on its state insurance exchange that backs up that much-studied estimate. Sen. Maryanne Jordan, D-Boise, questioned some of Birnbaum’s economic assumptions.

Sen. Marv Hagedorn, R-Meridian, noted Washington state’s experience; that state has expanded Medicaid, but still has charitable programs like those Birnbaum is promoting, and those programs still are struggling to meet needs. “I will concede that dealing with these issues are not easy,” Birnbaum responded. “That’s one of the reasons that we would suggest using transition money … from the state government.” He said Idaho could tap funds from its Catastrophic Health Care program or its Millenium Fund to transition members of the gap population to private charity care.

Birnbaum said his group’s charity-care proposals would target the chronically ill. “I think there’s nothing unreasonable about suggesting to young people that are able-bodied that you work and you pay for your insurance,” he told the lawmakers. “We want to encourage those that are able-bodied to work full time. I think that’s very important.”

Birnbaum said that while Medicaid expansion in other states has reduced the number of uninsured people, he doesn’t believe it has cut costs in the health care system.