Until conservatives in the Idaho Legislature convince their colleagues to choose what’s best for Idaho over talk-radio ideologies, the state’s taxpayers will continue paying for services they don’t get and 78,000 people will continue to be without health coverage.

The fact is Medicaid expansion is a no-brainer.

When Congress passed the Affordable Care Act (ACA), it required the states to expand Medicaid to cover individuals and families in-between the income thresholds for Medicaid and healthcare subsidies. Soon after, the Supreme Court ruled against that requirement, leaving each state responsible for deciding whether to expand Medicaid.

It should be noted that the federal government is picking up 90 percent of the cost. In other words, federal taxpayers are paying for it even if their state doesn’t expand Medicaid. So far, 28 states and the District of Columbia are delivering services their taxpayers are paying for.

Who would be covered by a Medicaid expansion in Idaho?
About 78,000 Idahoans who are currently uninsured. Pie-chart-of-coverage

Who pays now?
The emergency room tends to be these Idahoans’ place of primary care, which is expensive. Those costs are picked up by the counties’ indigent programs, the state’s Catastrophic Health Care Program and charities. Ultimately, the costs are passed to Idahoans through property taxes and higher insurance premiums.

Who are these people?
More than half have children in the home. And 68 percent of uninsured families have at least one full-time worker. They are food service workers, laborers in construction, farming and forestry, home health aides, childcare workers, retail workers. Also, they are people in transportation, janitorial, office and administrative support. In other words, they are our neighbors.

Why not expand coverage?
Here are two of the most common arguments against expansion.

1.) The federal government will reduce or stop paying its promised share, leaving an unfunded mandate — Idaho cans simply put a clause in an expansion that gives the state an option to opt-out should the federal funding falter.

2.) Adding more people to Medicaid is too expensive — Putting more people on Medicaid will drive up the price of the program, but that option is less expensive than continuing the path we’re on. The Center For Fiscal Policy estimates expansion will save Idaho $173 million in 10 years — not to mention the lives it will save.


What’s stopping it?

Far-right conservatives detest anything relating to the Affordable Care Act. Last week, the House voted to repeal the ACA for the 56th time, including both of Idaho’s U.S. Representatives.

Is there a plan?
Yes. The Governor’s Medicaid Redesign work group has put together a plan that mirrors other conservative states like Arkansas, Iowa and Indiana that have established their own framework for accepting the federal money. These so-called “redesigns” transform Medicaid expansion into something sufficiently different that conservative lawmakers will vote for it.

Sen. Brent Hill

A “no brainer” vs. “political realities”
Thus far, opposition to the ACA has won the day.

“The problem is, we’ve gotta deal with the political realities here, this year … I don’t know a single Republican in the Idaho Legislature who would right now support, you know, vote in favor of the Affordable Care Act.” — Senate President Pro Tempore Brent Hill


Rep. Fred Wood

But some cracks appear to be forming in conservative camp.

“Having looked into the economics of it, the health care of the citizens, the amount of taxes we pay into the federal coffers at this point to support this program that we’re not getting back, and the economic activity that we’re missing at this point in time, I think that it’s no-brainer to expand Medicaid.” — House Health and Welfare Chair Fred Wood


Rep. Eric Redman

It will not be easy to break through the staunchest ideologues.

“I came here to try to reduce federal government intrusion and this does really kind of worry me, quite truthfully,” — Rep. Eric Redman