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Inside Politics: Idaho's 'bait-and-switch' restriction to Medicaid expansion

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Idaho’s legislative attack on our health care began in earnest this week. Idahoans spoke publicly in Boise and Lewiston against a restriction designed to put people on taxpayer-subsidized health care plans rather than Medicaid Expansion. An estimated 28,000 Idahoans may be put at risk.

Idaho’s legislators went out of their way to decimate our state’s greatest legislative achievement in a generation during the 2019 session. Medicaid Expansion will bring home $400 million in our federal tax dollars, provide coverage for tens of thousands of Idaho families, shore up our rural hospitals, and create thousands of jobs statewide in the process. Why our elected leaders would try to destroy such a transformative piece of legislation — which you voted for — is anyone’s guess. But, the attack is real.

Idaho legislators put a myriad of restrictions on our Medicaid Expansion program.

Thankfully, many restrictions our legislators are seeking require federal approval. The first health care restriction, subject to your public voice, is presented as a “choice.” Idahoans earning between 100-138% of the federal poverty level (“FPL”) can buy subsidized health insurance rather than accept Medicaid Expansion benefits. This “option” is nothing more than a bait-and-switch plan which will cost taxpayers more money and provide Idaho families fewer health care benefits.

I will grant you this: “choosing” between taxpayer-subsidized private insurance plans and Medicaid Expansion sounds reasonable. Idahoans are independent-minded people who value real choice. I am no different. However, the restriction being sought seems more like a scam disguised as a “choice” which could put thousands of Idaho families at risk.

For starters, it is unclear whether Idahoans in the 100-138% FPL will know they have a choice in the first place. People at that income level can likely afford only the cheapest “Bronze” plans on the exchange which come with deductibles and co-pays in the thousands of dollars per year. In other words, those people have to shell out big money before the insurance even kicks in. Will they be given a side-by-side comparison of the cost and coverage of exchange-based plans versus Medicaid Expansion? We don’t know. Also, if someone chooses to stay on subsidized insurance — even though they qualify for Medicaid Expansion — and misses a premium payment, will they still receive health care? Again, we don’t know.

These seem like technical questions until you consider that your friends, family and neighbors may be set up for failure. If they are given a real choice between subsidized insurance and Medicaid Expansion and choose the former, I respect that. If they are only told about the exchange-based plans without knowing they qualify for Medicaid Expansion, that’s a false choice that will only harm Idaho families. I cannot, and will not, support that.

Secondly, any restriction, or “waiver,” to Medicaid Expansion must be “deficit-neutral.” In other words, if Idaho wants to implement this restriction, it can’t cost taxpayers more than simply shifting people to Medicaid Expansion.

Here’s the thing. Idaho’s own records indicate that paying for subsidized health insurance on the state exchange costs taxpayers almost DOUBLE what Medicaid Expansion would for those same people. A nonpartisan budget review conducted during the 2019 session shows this restriction could cost us $42 million a year. Where are the conservative voices talking about saving tax dollars? When you consider that Medicaid Expansion provides far more comprehensive and reliable services — for half the price — there is no reason the feds should give this restriction the time of day. It is my sincere hope they don’t.

The Medicaid Expansion battle has been fought and won in Idaho. You approved the program with an overwhelming 61-percent of the vote. Legislators fought all session to take that away from you, your families, friends and neighbors. Thankfully you still have a voice in this process. Please speak out against bait-and-switch health care laws that put Idaho families in jeopardy and weaken our communities. A federal judge recently ruled that your input must be considered by regulators when reviewing health care restrictions proposed by the states. You have until June 30 to do just that.

Click on this link and make sure you say “no” to false choices when it comes to health care in Idaho. Your friends, families and communities are counting on you.


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