February 23, 2014 in Opinion

Editorial: Idaho’s health care dithering comes with a high cost


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When it comes to health care for poorer citizens, it’s astonishing to see how much money an otherwise-frugal Idaho Legislature is willing to fritter away.

Whether through pure ideology or political preservation, state lawmakers have thus far rejected the Medicaid expansion provided for under the Affordable Care Act. In so doing, they’re forgoing the most obvious solution to two nettlesome problems: the county-financed medical indigency program and the state catastrophic health care program, both of which bleed money.

Last year, the Legislature pondered discontinuing both programs and accepting the Medicaid expansion when reports from two consultants outlined considerable savings. But the ACA, aka Obamacare, is a lightning rod among Republicans. Some lawmakers are spooked by the backlash from last year’s vote establishing a health care exchange. They fear challenges from the right in the upcoming primary.

For them, another Obamacare vote is out of the question, even if it pencils out. And, boy, does it.

This year, legislators are dipping their toes into Medicaid expansion without calling it that. A bill introduced last week features half of last year’s deal: a phase-out of the nettlesome county and state programs by 2016 while lawmakers search for a replacement.

Pay no attention to those consultants’ reports, at least not until this year’s election has passed.

Unfortunately for taxpayers – and for those without health care coverage – these postponements are becoming expensive. Starting in 2014, the feds offered full funding of Medicaid expansion in its first three years, and it looks as if lawmakers might skip them all. After that, the feds pay 90 percent and the state pays 10 percent, which is still a great bargain (and a much better deal than regular Medicaid).

But lawmakers have to say yes.

The medical indigency plan, funded with property taxes remitted to counties, is ill-suited to cut health care costs. Basically, it picks up the cost of services for those who have exhausted all resources. Because such patients have no insurance, they tend to get emergency care, which is the most expensive kind.

Under expanded Medicaid, many of these people – an estimated 100,000 overall – would have access to preventive care and a whole host of other services. And they wouldn’t have to go broke before having their bills paid. Plus, property tax payers would be off the hook.

Milliman, one of the state-commissioned consultants, projected the county-state plans would need an extra $284 million over the next decade. But if the state expanded Medicaid, it could save $6.5 million instead. The Idaho Hospital Association projected $407.4 million in savings.

Every year Idaho delays, those savings dwindle.

The good news is that Medicaid expansion is still a possibility, even if it is discussed in hushed tones. It’s too bad politics is exacting such a high toll in the meantime.

To respond to this editorial online, go to www.spokesman.com and click on Opinion under the Topics menu.

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