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Idaho could save $380M with Medicaid expansion

Idaho’s taxpayers could save $380 million over six years by agreeing to expand Medicaid coverage for more low-income people under President Barack Obama’s health care overhaul, according an analysis by the Spokesman-Review.

Currently, costs of caring for Idaho’s indigent population — often poor, single men with no children who don’t currently qualify for Medicaid — are borne by counties and the state as part of Idaho’s “Catastrophic Health Care Fund.” The total bill is expected to top $60 million next year.

Under Obama’s law, Medicaid would be expanded to cover many of those people, with the federal government picking up 100 percent of the tab until 2016. Support is pared gradually to 90 percent after 2020.

Though the U.S. Supreme Court upheld the federal Patient Protection and Affordable Care Act in June, justices ruled states couldn’t be punished if they didn’t expand their Medicaid programs. Gov. C.L. “Butch” Otter has a committee investigating what Idaho should do, with their recommendations due in a few weeks.

With lawmakers including House Speaker Lawerence Denney and House Majority Leader Mike Moyle arguing against Medicaid expansion, it’s unclear what Idaho will decide to do since the Legislature must sign off on any decision. Denney and Moyle still believe Idaho should do everything it can to fight it — including spurning Medicaid expansion.

“Resistance usually comes at a cost, but the state of Idaho must resist Obamacare,” they wrote in a guest editorial to Idaho newspapers distributed earlier this summer. “The cost of not resisting will be much higher.”

Other lawmakers, however, are pushing to accept the expansion, with Sen. Joyce Broadsword, R-Sagle, telling the Spokesman-Review she thinks the changes will provide relief for taxpayers — and encourage patients to take health care into their own hands.

“We’ve got a huge population out there of uninsured that are putting off health care needs, especially catastrophic care, because they can’t afford to go to the doctor,” said Broadsword, who is retiring from the Idaho Legislature to run for the Bonner County Commission.

Catastrophic fund managers estimate Idaho will spend $61 million next year on indigent medical care, split between county property taxes and state general funds. With costs expected to escalate by at least 7 percent annually for the next six years, the cost for the program would be $436 million.

Taking those changes into account, as well as the federal coverage starting at 100 percent for the newly eligible Medicaid recipients, Idaho would save $380 million over the next six years by replacing its indigent medical program with a Medicaid expansion, the newspaper reported.

A Kaiser Foundation study suggested Idaho would spend between $101 million and $133 million over the six years to expand its Medicaid program to more than 85,000 currently uninsured patients.

That includes many beyond those eligible for the indigent program. By that estimate, the state would save at least $300 million compared to what it’s spending now from state and county funds on indigent care.

Denney, R-Midvale, and Moyle, R-Star, have led the fight in the Idaho Legislature against “Obamacare,” including in 2010 when they helped pass a law requiring Idaho to sue the federal government over the revamp.

Expanding Medicaid must be blocked, they say.

Others, however, believe the two conservative Republicans have elevated narrow ideological objections to the Affordable Care Act over more pragmatic considerations, including what’s best for Idaho.

House Minority Leader John Rusche, D-Lewiston, a retired physician and insurance executive, says it’s a “no-brainer.”

“A good business analysis will show that for the citizens of Idaho, there’s an advantage to the Medicaid expansion,” Rusche said.


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