Anyone who says Medicaid expansion won’t hurt education or transportation spending either isn’t paying attention, is engaging in wishful thinking, or is just making stuff up. Last week, my friends from the Idaho School Boards Association tried to minimize the potential impact of Medicaid expansion on schools, going so far as to claim that increasing Medicaid enrollment by 20 percent would help schools. Ugh.
It’s not just that Medicaid expansion may impact the state budget: Medicaid has already impacted education and myriad other government programs. It will continue to do so.
With apologies in advance for the number of numbers you’re about to read, the facts speak for themselves. Whether measured by spending or by number of people served, Medicaid is growing faster than the state’s constitutionally-required education system, and not long ago Medicaid actually overtook education as the state’s No. 1 priority in terms of dollars and enrollees.
Over the past dozen years, Idaho’s population has grown at a compound annual growth rate of about 1.3 percent. Education and transportation spending have each increased by 2.9 percent. Spending on Medicaid? It’s grown at more than six percent annually. In fiscal year 2011, Medicaid overtook public school spending. Today, $2.4 billion goes to Medicaid while $2.1 billion goes to K-12 education. True, these figures include both state and federal funds. However, even if we consider just state general funds, the picture is even worse: At the beginning of this decade, state taxpayers spent less than $300 million on Medicaid. Today, the state’s general fund obligation for Medicaid is closing in on $600 million.
During Idaho’s 2006-2007 budget year, the average daily attendance in Idaho’s public schools was 250,980. The projected average-daily attendance for the current fiscal year, which started July 1, is about 285,200. In 2006-2007, fewer people were served by Medicaid than there were students enrolled in public schools. At that time there were 184,508 people on the government healthcare program. Today, there are far more Gem State residents on Medicaid (a projected 313,300 in FY 2019, even without expansion) than students in Idaho's K-12 public schools.
In 2007, the percentage of Idahoans attending public schools was 16.7 percent. The percentage of Idahoans on Medicaid was 12.3 percent. In FY19, it’s expected that, even without expanding Medicaid, nearly 18 percent of Idahoans will receive their healthcare coverage through Medicaid. That’s a compound annual growth rate of about 3.2 percent, while the percentage of Idahoans attending K-12 public schools will stay basically flat.
The Idaho School Boards Association claims that expanding Medicaid by voter initiative will benefit public school funding, in part, because it will negate the “need” for the state-county healthcare program that pays the medical expenses of the uninsured. The fact is, over the last 20 years, Idaho lawmakers have expanded Medicaid (albeit in smaller ways than is being contemplated today) with the excuse that such expansions would contain program costs and free up money for other programs, like education. The promised savings have not materialized.
Whether you think K-12 education is underfunded, funded just right, or overfunded, the fact remains: There’s a finite amount of money to go around. Simply stated: Expanding Medicaid will mean less money available for everything else—be it schools, transportation, or tax cuts.