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‘Crony deal’: Legislature was correct to reject the dual-waiver Medicaid expansion

‘Crony deal’: Legislature was correct to reject the dual-waiver Medicaid expansion

Fred Birnbaum
March 8, 2018
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March 8, 2018

Despite tremendous pressure from Gov. Butch Otter and his staff, the Idaho House of Representatives held firm against expanding Medicaid in Idaho. Legislators should be congratulated for their fortitude.

The waiver plan, under House Bill 464, was unsound and ill-timed. It is shameful that the Idaho Statesman provided such one-sided coverage of this issue.

House Bill 464 would have allowed Idaho to apply to the U.S. government for two waivers, one to enable those in the “Medicaid gap” to purchase health insurance using subsidies — known as Advanced Premium Tax Credits. The second waiver would have, in essence, pushed people with private insurance onto Medicaid.

Why are these issues tied together? There is no medical logic to this plan; rather, the linkage is due to one of the many ironies of Obamacare. Waivers to the Affordable Care Act are required to be budget neutral. This requirement is part of the ACA plan to make sensible changes almost impossible. Now, even after witnessing its manifest failures in countless states, Idaho almost took the Medicaid-expansion bait.

Some bought into the fallacy that this scheme would save taxpayers money. This plan would have pushed people, who have high-cost, complex medical conditions, off of private insurance and onto Medicaid (read taxpayers). This notion is one that only ACA true believers could swallow. The individuals with severe medical conditions like hemophilia would have their data provided to the Idaho Department of Health and Welfare by their very own private insurers. You read that correctly.

Whether these very ill individuals desired Medicaid or not, their data would be shared with the government, which would inform them that they either enroll in Medicaid or lose the Advanced Premium Tax Credits that enable them to purchase private insurance. If all of this sounds sinister, it really is. The Department of Health and Welfare insists that the vast majority of these people could keep their same doctors. Doesn’t the assurance that these very ill people can keep their doctors sound eerily familiar to President Obama’s mantra, “if you like your doctor, you can keep your doctor”?

Tying all of this together is the suggestion, because it can’t be called a promise, that insurance premiums on the individual market will come down around 20 percent sometime in the future. This supposition, neither required by the bill nor enforceable by law, is the glue that holds this entire crony scheme together.

So there you have it. Expand Medicaid by spending $101 million in taxpayer appropriations to goad roughly 2,000 to 3,000 people onto Medicaid. Then, turn around and offer approximately 35,000 low-income, mainly able-bodied, adults health insurance with the same 10 essential benefits that Gov. Otter’s recent executive order is, correctly, attempting to circumvent.

So who really benefits from this scheme? Idaho’s medical-industrial complex, which will both offload nearly $200 million in privately insured costs onto the taxpayer with one hand and then scoop up 35,000 subsidized customers with the other hand. This is a classic example of a crony deal that, unfortunately, is the hallmark of our current medical system.

As stated earlier, we owe many thanks to the Idaho House of Representatives for putting a halt to this scheme.

Note: The Idaho Statesman first published this article. You can read the original post here. 

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