Bill Description: House Bill 123 would repeal Medicaid expansion in Idaho.

Rating: +8

Does it create, expand, or enlarge any agency, board, program, function, or activity of government? Conversely, does it eliminate or curtail the size or scope of government?

Medicaid is one of the largest and most expensive government programs, always growing in size, scope, and spending, while increasing dependence on government and forcing private competitors out of the market. The cost of Medicaid expansion in Idaho has soared from $403 million in FY21 to over $1 billion requested for FY24.

House Bill 123 would repeal Section 56-267, Idaho Code, and make other adjustments to Idaho Code in order to repeal the Medicaid expansion Idaho adopted after the Affordable Care Act (Obamacare) went into effect. This would result in a significant reduction in the size and scope of the Medicaid program.

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Repealing Medicaid expansion would not only reduce the size and scope of the Medicaid program, but it would encourage participants to work and thereby get insurance from the exchange. The work those individuals would perform and the income they would receive would have the additional benefit of freeing dependency on other programs like food stamps.

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Does it transfer a function of the private sector to the government? Examples include government ownership or control of any providers of goods or services such as the Land Board’s purchase of a self-storage facility, mandatory emissions testing, or pre-kindergarten. Conversely, does it eliminate a function of government or return a function of government to the private sector?

Health care should be provided and obtained in the private sector. Any time individuals are enabled or encouraged to seek health care or health care subsidies through government, the private market is weakened and dependence on government is increased. Conversely, when government programs are shrunk and individuals are removed from them, those individuals will participate in the market rather than rely on government handouts.

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Does it increase government redistribution of wealth? Examples include the use of tax policy or other incentives to reward specific interest groups, businesses, politicians, or government employees with special favors or perks; transfer payments; and hiring additional government employees. Conversely, does it decrease government redistribution of wealth?

Medicaid is funded through a combination of tax dollars and government debt, which might be defined as “tax obligations deferred.” Any time individuals are enabled or encouraged to seek services through government, or to seek subsidies for it from government, those subsidies or services are funded through redistribution. Conversely, when government programs are shrunk and individuals are removed from them, the amount of redistribution taking place is reduced. 

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Does it increase government spending (for objectionable purposes) or debt? Conversely, does it decrease government spending or debt?

The Fiscal Note for House Bill 123 says that repealing Medicaid expansion in Idaho would save taxpayers more than $842 million annually. The request for FY24 is more than $1 billion. 

We have seen exponential growth in Medicaid spending in recent years, with some research suggesting annual growth could reach 20%. Even using a more conservative estimate of 10% annual growth, repealing Medicaid expansion in Idaho could save a total of $16 billion over the next decade.

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Medicaid, and Medicaid expansion in particular, has been one of the largest ongoing drivers of federal debt in recent years. Repealing Medicaid expansion at the state level is one way that states can reduce the skyrocketing federal debt that is mortgaging the futures of our children and grandchildren, all to subsidize this generation's unsustainable consumption. 

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Does it violate the spirit or the letter of either the U.S. Constitution or the Idaho Constitution? Examples include restrictions on speech, public assembly, the press, privacy, private property, or firearms. Conversely, does it restore or uphold the protections guaranteed in the U.S. Constitution or the Idaho Constitution?

The Medicaid program lies far outside the enumerated powers granted to the federal government in Article I, Section 8 of the U.S. Constitution. By repealing Medicaid expansion, Idaho would be taking a step toward reversing the long trend of federal expansion outside the bounds of the Constitution.

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Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the Tenth Amendment. Conversely, does it restore or uphold the principles of federalism?

The majority of funding for Medicaid comes from the federal government, which means that as the program grows, the state becomes increasingly dependent on federal dollars, and those federal dollars become an ever larger share of the state budget. As has been seen with Medicaid and other federal programs, these dollars come with strings that obligate the state to comply with policies and priorities that go against the values and best interests of the state. 

Repealing Medicaid expansion would significantly reduce Idaho's dependence on the federal government. 

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