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House Bill 284 — CAT Program Appropriation

House Bill 284 — CAT Program Appropriation

Fred Birnbaum
March 5, 2021

The Idaho Spending Index examines appropriation bills on several fronts to add some important context to lawmakers’ discussions as the spending bills are considered on the House and Senate floors. As we look at the budget, we consider the following issues:

Does the agency requesting these funds serve a proper role of government? Has wasteful or duplicative spending been identified within the agency, and if so, has that spending been eliminated or corrected? Have budget-writers reviewed existing outlays to look for opportunities to contain spending, e.g., through a base reduction? If there is a maintenance budget, is that maintenance budget appropriate? Are the line items appropriate in type and size, and are they absolutely necessary for serving the public? Does the budget contemplate adding new employees or programs? Does the appropriation increase dependency on the federal government?

Our analysis is intended to provide lawmakers and their constituents with a frame of reference for conservative budgeting, by summarizing whether appropriation measures contain items that are truly  objectionable or legitimate and worthy of support.

Bill Description: Catastrophic Health Care Program FY22 Appropriation

Rating: -1

The CAT program was established to meet the needs of the medically indigent residents of Idaho who don’t qualify for other programs. The state portion of this program is a back-stop to counties’ programs for medically indigent residents. Individuals who can’t meet their medical bills can apply for financial relief from their medical bills from the counties in which they live, with the view that they will eventually pay the county back. These bills are not “Idaho’s bills,” but the medical bills of the people that incurred them. 

One of the key selling points of Medicaid expansion during the 2018 public debate was that Medicaid expansion would reduce the costs of the CAT program. The 2018 Milliman Report projected cost savings, and the state accepted their projections. The report forecasted that costs would fall 50% by FY22. There is no evidence that this goal will be achieved.

The Idaho Hospital Association along with counties were enthusiastic supporters of Medicaid expansion with the view that it would lead to greatly reduced medical indigency costs. This has not happened yet. It is time to unwind the CAT program, it is time for accountability.

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