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Governor Little is correct to oppose the use of Medicaid for sex reassignments, but he needs to go further

Governor Little is correct to oppose the use of Medicaid for sex reassignments, but he needs to go further

Fred Birnbaum
May 8, 2023

We applaud Governor Little for making a public declaration that taxpayer-funded Medicaid, the medical welfare program that covers about 450,000 Idahoans, should not be used for any gender reassignment treatment or surgery.

The Idaho Freedom Foundation raised the issue concerning the use of Medicaid for any sex change treatments, including hormone therapy. We believe then, as we do now, that taxpayer funds should not be used for sex change treatments for adults. And that sex reassignment is not an appropriate treatment for minors. 

During the 2022 legislative session, the legislature passed H71, The Vulnerable Child Protective Act, which prohibits puberty blockers, cross-sex hormones, and sex reassignment surgeries for children under the age of 18 when administered or performed for the purpose of changing the appearance of a child’s sex. 

The bill passed overwhelmingly, but it did not address the issue of publicly funded sex reassignments for adults. The issue of publicly funded sex reassignments using Medicaid coverage is critically important. There are over 140,000 able-bodied adults covered under Medicaid expansion. Just imagine if a significant number of these adult participants start clamoring for gender reassignment or attempt to stay on Medicaid to initiate these treatments. How costly will that be? 

The Governor is late to the party because the explosion of Medicaid participants makes Idaho’s taxpayers increasingly vulnerable to the demands of new adult Medicaid participants. During the last several legislative sessions, he has been noticeably silent about a program that spends one out of three dollars that the state appropriates in all funds. 

What happens if a federal judge rules that Idaho’s Medicaid program must pay for adult gender reassignment just like the federal courts ruled that the convicted child rapist Edmo must be provided with gender reassignment surgery at taxpayer expense? In fact, as I write this, two plaintiffs have sued the Idaho Department of Health and Welfare for denying them “genital reconstruction surgery.”

This brings up the central problem with joint federal-state programs like Medicaid. The federal government probably believes it can call the tune because Idaho just appropriated $4.54 billion for Medicaid for Fiscal Year 2024 (FY24). And the federal government provides 66% percent of these funds, just over $3 billion. And no, this isn’t Idaho just getting our taxpayer money back because Medicaid was further expanded during COVID using borrowed money. 

So, this is the real dilemma facing Governor Little and the Legislature, Medicaid has been allowed to grow unchecked for years. In fact, from FY20 to FY24, the appropriation has increased 60%. And now the federal government, under President Joe Biden, is in a position to tell Idahoans to advance the transgender agenda. Or not, if Idaho seizes the high ground and pushes back, even potentially repealing the provision of Medicaid services to able-bodied adults. 

Idaho Freedom Foundation
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