Bill Description: House Bill 753 would expand Medicaid to create an Assertive Community Treatment (ACT) program and team.
Rating: -6
Does it create, expand, or enlarge any agency, board, program, function, or activity of government? Conversely, does it eliminate or curtail the size or scope of government?
Medicaid is one of the largest and most expensive government programs, always growing in size, scope, and spending. Through it, people are becoming increasingly dependent on government and private providers are being forced out of the market.
House Bill 753 would create Chapter 25, Title 56, Idaho Code, calling for a “state plan amendment” to “provide assertive community treatment as a rehabilitative service.”
The bill defines “Assertive community treatment” or “ACT” as “a multidisciplinary, community-based behavioral health service model that provides intensive, comprehensive, and individualized treatment and support services to eligible participants with serious and persistent mental illness.”
The bill also calls for the establishment of “ACT teams” that would be available 24/7 and “address complex behavioral health needs through integrated psychiatric, medical, substance use, rehabilitative, and peer support services.”
This program represents a significant expansion of government and of Medicaid, specifically.
(-1)
Does it transfer a function of the private sector to the government? Examples include government ownership or control of any providers of goods or services such as the land board’s purchase of a self-storage facility, mandatory emissions testing, or pre-kindergarten. Conversely, does it eliminate a function of government or return a function of government to the private sector?
The provision of health care services is not the proper role of government. It is the proper role of the free market. Moreover, many of the specific problems the ACT teams would be tasked with combatting are issues that should be dealt with by families, churches, and private charities.
(-1)
Does it increase government redistribution of wealth? Examples include the use of tax policy or other incentives to reward specific interest groups, businesses, politicians, or government employees with special favors or perks; transfer payments; and hiring additional government employees. Conversely, does it decrease government redistribution of wealth?
All forms of government-funded or government-subsidized health care, including Medicaid, are funded through a combination of tax dollars and government debt. Any time individuals are enabled or encouraged to seek health care or health care subsidies through government, they receive services funded through redistribution.
(-1)
Does it increase government spending (for objectionable purposes) or debt? Conversely, does it decrease government spending or debt?
All forms of Medicaid expansion require increased government spending, even if a majority of the spending comes from federal funds. Federal money comes either from taxpayers or from taking on more debt, which leads to higher inflation and devalued savings. And someday, the bill will come due for American taxpayers.
House Bill 753’s fiscal note estimates the fiscal cost to the general fund to administer ACT is $1.3 million for fiscal year 2026 and $3.9 million for fiscal year 2027.
This estimate does not include the significant federal spending involved in Medicaid.
The program that would be created by this bill would be allowed to grow, essentially without limit. The bill specifically says, “The number of participants served by assertive community treatment teams shall be determined based on demonstrated clinical need, provider capacity, and compliance with fidelity standards and shall not be subject to statutory enrollment caps.”
(-1)
Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the Tenth Amendment. Conversely, does it restore or uphold the principles of federalism?
A majority of the funding for Medicaid comes from the federal government, which means that as the program grows, the state becomes increasingly dependent on debt-financed federal dollars, and those federal dollars become an ever-larger share of the state budget. As has been seen with Medicaid and other federal programs, federal dollars come with strings that obligate the state to comply with policies and priorities that go against its best interests.
(-1)
Beyond the federal funding, this bill would also require the Department of Health and Welfare to “establish an assertive community treatment program consistent with a standardized, nationally recognized assertive community treatment framework and the state's adopted fidelity model.”
An Idaho-centric model should be based on Idaho’s needs not tied to a “standardized, nationally recognized” framework.
(-1)
