OPINION: Repeal Medicaid expansion and who pays? You

Idaho’s working poor have never been on the GOP-led Legislature’s radar.

You could see their indifference toward people earning too little to afford subsidized private health insurance under Obamacare but unable to qualify for Medicaid. For years, lawmakers remained idle. Even the plight of an uninsured Idaho Falls woman who died from untreated asthma — or the doctor who accused lawmakers of having her blood on their hands — failed to move them.

Nothing happened until Idaho voters took matters into their own hands in 2018 and passed Medicaid expansion by nearly 61%.

Ever since, GOP lawmakers have tried to sabotage the move.

It happened again earlier this year when Rep. Jordan Redman, R-Coeur d’Alene, tried to dare the federal Centers for Medicare and Medicaid Services to grant a series of draconian waivers, such as work requirements for cancer patients, or cancel the program by 2025. Thanks to five Republicans and three Democrats, his bill failed to clear the House Health and Welfare Committee.

But many of those people are gone. The newly constituted GOP Legislature is even more extreme — and President-elect Donald Trump’s administration may be more inclined to cooperate.

“... The current makeup, at least in the House, knows that we need to make some corrections to Medicaid expansion,” Redman told the Idaho Capital Sun’s Kyle Pfannenstiel.

It surely will not keep many of these lawmakers up at night if 81,553 of their fellow Idahoans lose access to the preventive care or cancer screenings that have enhanced their health and even kept them employable.

Just the same, they’re not helping the Idaho taxpayer, either.

For starters, Medicaid expansion is far from the runaway budget-buster that Redman and others would have you believe. The federal government covers 90% of its cost, and the hit on Idaho’s treasury has not outpaced the overall rate of state spending. In other words, Medicaid expansion is not drawing resources that would otherwise go to other programs, such as public education.

Eliminate it and you’re back to relying on health care Band-aids — all covered 100% by state and local taxpayers — such as the Catastrophic Health Care program, local county medically indigent services, state-covered health care for prison inmates and mental health programs. By one estimate, the changeover would net an $8 million increase in state and local expenses.

And if lawmakers refuse to restore those programs, who would pay?

You would — through higher medical bills and depleted health care services.

If the working poor can no longer rely on Medicaid, the cost of care they receive in hospital emergency rooms will be cost-shifted to people with private health insurance.

Nearly half of Idaho’s hospitals are losing money and the vast majority of those are the state’s 27 critical access hospitals that serve smaller communities. In 2022, the most recent year available, Idaho hospitals absorbed $78 million in charity care and $203 million in bad debt.

Throw the entire burden of repealing Medicaid expansion on hospitals and you’ll see even more erosion in the services they offer. More labor and delivery units will close. Behavioral health and home health services will be cut back.

It’s not just Idaho’s hospitals that are at risk.

Lawmakers are playing with fire with the state’s economy.

Two years ago, economist Steve Peterson concluded the influx of federal Medicaid expansion funds added $713 million to Idaho’s gross domestic product and contributed to 9,250 jobs.

Medicaid expansion alone added $14.11 million in state sales tax revenues, $14.8 million in new state income taxes and $8.97 million in property tax collections.

Besides, why are Idaho Republicans crying poverty now?

If Idaho can’t afford Medicaid expansion, why have lawmakers seen fit to pass four rounds of income tax cuts — primarily to benefit Idaho’s wealthiest families and corporations — totaling nearly $1.9 billion? Each year, the state will have about $948 million less to spend.

Add to that the $560 million House Speaker Mike Moyle, R-Star, has spent these past two years on lowering residential property taxes rather than updating the Homestead Exemption for nearly a decade of inflation.

If Idaho is so short of money, why are Idaho GOP lawmakers so determined next year to pass a voucher bill, allocating tens of millions of dollars to subsidize the education of students already attending private schools?

Don’t expect compassion from these lawmakers.

Nor can you count on their respect for the bottom line or even the health of the Idaho economy.

The common denominator? Idaho’s Republican lawmakers don’t like being told what to do. Here is their chance to finally put you voters in your place. — M.T.