Idaho’s Proposition Two is a ballot measure that would allow Medicaid expansion to take place in the Gem State.
The state's lawmakers have repeatedly turned down proposals to expand the Medicaid rolls in the state. The original Affordable Care Act, passed by Congress under President Obama, provided that Medicaid would be offered to anyone making under 100% of the federal poverty level. But that provision was overturned by the Supreme Court. States then could decide if they would move individually to expand Medicaid coverage. So far, 33 states have taken that step.
Proponents of expanding the coverage in Idaho say, because of earnings requirements under ACA, and the way Medicaid is set up currently in the state, there are an estimated 62,000 state residents who make too little to qualify for subsidies under ACA, or make too much to qualify for Medicaid.
Prop Two proponent Emily Strizich says the end result is many people who make under the federal poverty level and who are working full time, have no way of finding affordable health care.
“For a family of four, if they make over $5,000 a year, they do not qualify for any assistance under Medicaid. And to be able to get a subsidy, they need to make at least $25,000 a year, so that leaves a big gap. We know Idaho has a high number of minimum wage workers, so if you’re working 40 hours a week at minimum wage, that’s only $15,000 a year,” she said.
Those opposed to the expansion say some of the poorest workers in the state still qualify for subsidies under ACA, which means they're getting bargain health coverage.
Fred Birnbaum is from the Idaho Freedom foundation, a conservative think-tank. He cites the case of a single low income individual with no dependents.
“If your income was as low as $12,250, at age 33 a silver plan with no deductible, your cost would be $11 a month. If your age was 55 it would be $225 a month,” he said.
Emily Strizich says that scenario is for someone who is right at the 100% point of the federal poverty level, and that anyone below that income will not qualify for ACA subsidies. In addition, if they are a parent with a single child, and they make more than $289 gross pay a month, they make too much to get Medicaid.
The proposition calls for changing the system so anyone making up to 138% of the federal poverty level will qualify for Medicaid.
Opponent Fred Birnbaum worries that some will take advantage of changes to the system, and that it will encourage people to not find work in this currently robust economy.
“You’re basically saying to people, you don’t have to work, even if you are able-bodied, you’ll get health care or if you do work, don’t earn over this amount, or you’ll lose your subsidized health care,” said Birnbaum.
Proponents say the state will actually save money by expanding Medicaid to cover that gap population. As it stands, the federal government will pay 90% of the expansion, with the state picking up the rest.
Emily Strizich says because the state currently allocates money for an indigent and catastrophic coverage fund for those that need it, that expense will go away once Medicaid enrollment is increased.
“Last year the legislature passed a bill, it was about $36 million for the catastrophic fund, and I know here in Latah County, when I talked to the commissioners, they’re spending between $500-600,000 per year on indigent funds, so that 10% state cost would be absorbed by the state cost and indigent funds,” said Strizich.
Birnbaum says while the feds are now currently funding the Medicaid expansion at 90%, that may not always be the case.
“If the federal government has to bring its books into balance, then it won’t be able to pay 90%. Traditional Medicaid is funded at a 70/30 ratio. Let’s say they say they’re both going to be funded at a 70% ratio. That means Idaho will have to pick up 30 and not 10. And that could be several hundred million more for Idaho,” he said.
An actuarial firm, Milliman, conducted an analysis for the Idaho Department of Health and Welfare on the costs of Medicaid expansion.
The report indicates that Medicaid expansion in a single year would cost the state about $45 million but will also generate about $40 million in those offsets from the indigent fund. The net total 10-year cost estimate in state funds is $105 million.
Strizich says that may only tell part of the financial side of the issue, and there are likely to be some other cost benefits related to the expansion.
“You know we would have more physicians and healthcare providers working. You would have more services being paid for. In St Maries, for example, they just had to close their OB department, so if you were able to re-open the OB department, and hire another physician to work in that community, you know her family is going out to dinner or getting haircuts,” said Strizich.
Strizich cites a University of Idaho study that estimates some $20 million could be added to Idaho tax rolls if the expansion is approved.
Birnbaum argues that so called “multiplyer” effect only works in a recessionary economic period, and not in the current booming economy.
