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Friday, December 6, 2019  Spokane, Washington  Est. May 19, 1883
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Opinion >  Guest Opinion

Dr. Kenneth Krell: Idaho at crucial point for Medicaid expansion

UPDATED: Sun., March 5, 2017

By Dr. Kenneth Krell For The Spokesman-Review

Boise State University recently released the Idaho Public Policy Survey, conducted December 3-8 2016, and found 70.8 percent of Idahoans favor the governor and state Legislature taking action to provide the 78,000 low-income citizens in the gap with access to quality health care.

So support for closing the gap has actually increased about 10 percent from the last poll conducted a couple of years ago.

Yet the best the Legislature has proposed so far this session is $10 million. The House bill was pulled for lack of support, and on Friday a nearly identical Senate bill was introduced – to be paid for from the state’s Joint Millennium Fund (tobacco settlement money) – to provide primary care services. Both bills are less than the $30 million Gov. Butch Otter proposed last year. It equates to approximately $125 per gap individual – not enough to cover recommended screenings and an annual exam, as former Rep. John Rusche pointed out.

How would the money be allocated? According to the sponsor of the House bill, Rep. Fred Wood R-Burley, “Basically on a first-come, first-served basis. As I understand it, that’s the way it’s going to have to work.”

So line up, Idahoans.

The New York Times and the Washington Post have essentially ridiculed Idaho’s feeble attempts to skirt Medicaid expansion. As the Post said February 9 in a headline, “Republicans in Idaho tried to design a better plan than Obamacare – and failed.”

But time may be running out – forever – for Idaho to ever have the opportunity to provide comprehensive coverage for the gap population. On February 16, House Speaker Paul Ryan, two committee chairman and new Secretary of Health and Human Services Tom Price outlined their draconian plan to replace the ACA. Medicaid would be replaced by block grants to the states.

And while the details aren’t clear (as they never are with these broad Republican proposals), block grant money would likely be allocated to the states based on current federal dollars, so likely the 19 states like Idaho who have not expanded Medicaid would lose forever.

The Ryan paper contains hugs gaps, not indicating how large tax credits would be to replace insurance subsidies or the allocation specifics of block grants, and the 14 Republican governors whose states have expanded Medicaid are not going to stand by and let those dollars dry up, but for non-expansion states like Idaho it may be a lost opportunity to share in those federal dollars – our tax dollars.

Ryan’s paper claims “on its current path, the Medicaid program is on unsustainable footing.” That’s simply not true. A recent Congressional Budget Office Report noted that if current policies are maintained overall federal spending on health care will increase from 5.5 percent of GDP to 8.9 percent by 2046, a big jump, but expanded Medicaid would increase from 2.3 percent to 3.1 percent, a modest increase.

Idaho has been here before. As Bryan Clark pointed out in the Idaho Falls Post Register, because Idaho had very poor welfare funding in 1996 when welfare was turned into a block grant, we have essentially the same federal welfare dollars now as then. So while New York receives $2,600 per child, Idaho receives $400. And poverty in Idaho has increased from 13 percent of citizens below the federal poverty level to 16 percent, and deep poverty from less than 4 percent to more than 6 percent. It’s income inequality by state – and fixed forever in federal allocations.

Financially, it’s becoming clearer that Medicaid expansion improves a state’s financial picture, although block grants could change that total amount of dollars. Adding 78,000 to Idaho’s pool will greatly enhance our long-term Medicaid funding, even if the percentage of per enrollee reimbursement were to drop from 90 percent to 50 percent, as Ryan has proposed. It won’t drop that much – Republican governors who have seen their citizens achieve health coverage won’t stand for it.

And meantime 78,000 Idahoans continue to suffer and die – 325 at least per year, nearly one per day, with unfathomable suffering by those who live in constant fear of getting sick with no coverage. These are our fellow citizens, the majority of whom work, the rest predominately severely disabled, and we must not forget their plight. This is not how we treat each other as Idahoans.

So when the Legislature is debating $10 million for health care for the poor, tell them no way are we going to stand for that mistreatment of hard working and disabled Idaho citizens. For $122 million, the Legislature can fully expand Medicaid this session. To miss this opportunity may lock us in forever as a second-class state.

Seventy-one per cent of Idahoans support Medicaid expansion. We must make our voices heard.

Kenneth Krell is an intensivist at Eastern Idaho Regional Medical Center.

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