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“When are you two going to buy a house?” I asked a young friend. He is picking up side jobs in his skilled vocation as he seeks to build a reputation in preparation for opening his own business. His wife is in her first year of teaching. “Well,” he said, “we have a large medical bill to pay off before we can even think of it.” He explained why they had no insurance coverage at that time. Wanting to preserve their credit score for a home and business loan, bankruptcy is not an option. In Idaho and other states who have not expanded Medicaid to cover the “gap” population, this is not an isolated story. Some select bankruptcy, but that itself is costly.

I am illustrating why Medicaid expansion is not a handout, but a hand up. Without the burden of unpaid medical costs, an individual or a family can participate in the more worthwhile pursuits which add value to our economy while unpaid medical costs do not impact the bottom line of the providers. Some individuals elect to stay away from medical care in all but the direst of situations and in a sense, self-insure, but that is a public health problem. It is public health because it hinders productivity when disease spreads or individuals are absent longer than would be necessary with proper care and medication.

Most of the employment in this country is within small businesses or the self-employed. Medical insurance is less expensive when the risk is spread among large groups of people. Unfortunately, small businesses or the self employed have no vehicle for gaining these cost savings. Hence the understandable outcry over the cost of medical care and insurance. It is also a hinderance to support for Medicaid insurance from those who make too much money to qualify for this state subsidized plan.

These perspectives, while understandable, do not consider the bigger effect of a more robust group of consumers. Economies run on the ability for individuals and companies to exchange money for goods and services. When spending is constrained to a smaller group of goods and services, the economy gets smaller and fewer people have any opportunity to participate. Since a good amount of the money which will pay for the added cost of Medicaid will come from sources not now available in Idaho, the economy will expand by more than the relief of medical debt alone would account for. Many businesses will see the result in their bottom line.

Medical care has always been a human need. Those who could survive everything from disease to traumatic injury have carried on building our advanced civilization. What is different today is the amount of care that can be given. That has expanded our economy by providing a huge increase in employment within the industry. It has created a cost for consumers that must be contained. It has also become, for most people, part of the safety and security that is the bedrock of the hierarchy of human need.

The topic of what humans need in order to thrive should be the first thing office holders consider when executing their duties. Of course, there are a slew of issues to consider. There is a balance between what is ideal and what seems possible. The case of Medicaid expansion is a half measure, but it moves the problem toward a more ideal situation of safety and security for a significant number of Idahoans and the people who care about them. Our Legislature must enact it. They should strive for the earliest possible date for it to take effect. They can then leave Boise satisfied that they have, indeed, looked after the safety and security of Idahoans. As a bonus, they will have added to the resiliency of Idaho’s economy.

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Linda Brugger retired from the Air Force and is a former chairwoman of the Twin Falls County Democrats.

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