Ever since the U.S. Supreme Court’s decision to turn the Affordable Care Act’s Medicaid mandate into a voluntary matter, states have had to decide whether to take the federal deal to expand health care coverage for poor people. Idaho chose a deliberative path by commissioning two studies by out-of-state consultants at a cost of $195,000.
We think the choice is obvious, because the federal government is picking up 100 percent of the costs in the early years and 90 percent thereafter. In fact, the argument for Idaho is stronger than in other states, given the way the current system is structured to deal with catastrophic health care costs for poor people.
Nonetheless, if state leaders needed to see those cost savings on a spreadsheet, fair enough. But if they reject the Medicaid deal after reading the bottom line, then this exercise will have been a total waste of time and money.
You don’t need two studies to reject the deal on principle.
Gov. Butch Otter put together a 15-person working group to study Medicaid expansion. After reading the reports from the Leavitt Group and Milliman, the panel voted unanimously on Friday to accept the expansion of Medicare.
And why not?
Over a 10 ½-year window, “You save $6.5 million if you expand. It would cost you $284 million if you don’t,” a Milliman consultant told the working group. Milliman notes that the savings continue in the long run.
The Idaho Hospital Association reports $407.4 million in savings over the same time frame. The Spokesman-Review’s analysis in September estimated the six-year savings to be $380 million.
Though the amounts vary, one fact remains constant: Idaho would punish its own citizens and taxpayers if it rejected this deal.
The reason Idaho would benefit so much is tied to the unique way it currently finances coverage for the poor. Local property tax dollars are funneled to the state’s general fund, and money is sent back to local governments to disburse. Under federal reform, many of the people the state currently subsidizes would be shifted to Medicaid.
By turning down expansion, Idaho would be leaving those who pay property taxes fully on the hook. The working group, correctly, sees that option as foolhardy.
“If we could have 90 percent to 100 percent of that paid by the federal government, why wouldn’t we do it?” asked Tom Faulkner, a Gooding County commissioner.
The only reason to reject this deal is out of ideological opposition to the Affordable Care Act. Idaho lawmakers put all their chips on the law being rejected by the Supreme Court or dismantled by a new president. They lost both bets. In doing so, they rejected federal money to set up health care exchanges and now have to find state funds.
Doubling down on that act of spite harms poor people and property owners. State leaders should rise above that instinct and take the money.