House Bill 345 — Catastrophic Health Care Supplemental Appropriation

House Bill 345 — Catastrophic Health Care Supplemental Appropriation

Fred Birnbaum
March 19, 2021
Fred Birnbaum
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March 19, 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, Supplemental FY21 Appropriation

Rating: -1

Note: SB1081 an earlier version of this supplemental for $6 million failed in the House on a 33-35 on 3/3/21. This bill simply reduces the appropriation by $100.

The CAT program was established to meet the needs of the medically indigent residents of Idaho who don’t qualify for other programs. This legislation would add $5.999 million in General Funds to the CAT program for FY21.

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, especially if separate legislation H316 does not pass the Senate. H316 would wind down state obligations to the CAT fund. 

What is particularly troubling about this $5.999 million supplemental is that it comes on top of a FY21 appropriation of only $3.5 million, which clearly was not enough to meet the caseload costs, given the FY18-20 cost history. The FY21 original appropriation was a clear example of poor budgeting, and this supplemental request is simply a reflection of that. 

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