Another view of Armstrong’s Medicaid moral high ground

Fred Birnbaum Articles

On an Idaho Statesman’s webpage video, Idaho Department of Health and Welfare Director Richard Armstrong is shown surrounded by glum-looking colleagues. Why glum? Because, Armstrong asserts, the Idaho Legislature allows those in poverty to die younger. Armstrong says, “It is immoral and wrong to allow these individuals to deteriorate.”

What is Armstrong concerned about? Medicaid expansion, or more accurately, the lack of expansion.

Yes, we should help those in need who truly have chronic medical conditions. However, in his call for Medicaid expansion the director glosses over a number of points we would do well to consider before embarking on a major, costly, government program expansion.

To begin, let’s get an understanding of the basics. In 2015, the average number of people enrolled monthly in Medicaid was about 278,000. This is a 50 percent increase over 2006. The total program cost for fiscal year 2015 was close to $2 billion of federal and state tax dollars, a 60 percent increase over fiscal year 2006. The recently-authorized fiscal 2017 Medicaid budget is 12 percent higher than the 2015 expenditures.

Where does this money come from? Many commentators assume the program is paid for with our taxes and that Idahoans are merely getting back their share of taxes paid. No, this is not accurate.

Medicaid is not a discretionary program. Rather, it is an entitlement or “mandatory” program. This means, when we spend more on this program we merely add more to the federal deficit and more to our already-mountainous national debt.

I would ask Director Armstrong, what is moral about saddling future generations with trillions of dollars of debt to pay for programs that benefit people today? Yes, current taxpayers pay interest on that debt, but that’s a small drop in the debt bucket. Simply stated, one cannot claim that we are getting our taxes back – because, no, we are not.

Further, hardly a day goes by when we don’t read about the cost increases ordinary Idahoans endure as the health plans they purchase increase at double-digit annual rates. Is it moral to ask Idahoans to pay more for their own insurance and potentially higher future taxes to fund medical care for others – when they can barely afford their own?

Finally, let’s consider those who would be covered by the Medicaid expansion Armstrong seeks. We’re told there are 78,000 people in the “gap population,” that is, people who don’t qualify for insurance subsidies under the Affordable Care Act, nor qualify for traditional Medicaid. We can assume that a percentage of this group truly has chronic medical conditions. However, certainly not every single person in the gap has chronic health issues. This point is bolstered by the Milliman actuarial report on the Medicaid gap population, which projects that the majority are under 34, typically a healthy group, and have no dependents.

Rather than cast a wide net for Medicaid expansion — an expansion that would include college students, who work part time and live at home — we should focus on helping those who are most critically in need. This seems a more reasonable approach than blazing a new path that expands a costly entitlement program and which would burden future generations with even more federal debt.