The decision of the Idaho Association of Commerce and Industry (IACI) to back Medicaid expansion creates a bit of a credibility problem for the business lobby organization. Not so long ago, IACI argued that the state was better off creating an insurance exchange, lest the federal government do it for us.

Alex LaBeau, the president of IACI, often remarks that given the choice, Idahoans are much better off if they can pick up the phone and call Idaho officials, such as the Department of Environmental Quality instead the U.S. Environmental Protection Agency. His argument won the support of lawmakers, who voted to implement Obamacare with the creation of a state insurance exchange.

Now, IACI says the state should further implement Obamacare by accepting the optional expansion of Medicaid. IACI reasons that Idaho can do what Arkansas did, get permission from the federal government to use private insurance as an underlayment to expand the health care program. Expanded Medicaid, by the way, would replace the state-county program that provides health care services for the poor.

LaBeau, in his letter to Gov. Butch Otter outlining IACI’s position, said Medicaid expansion (which he and others now call “Medicaid Redesign”) “addresses the inherent inefficiencies in the county indigent program and the state’s catastrophic program, and minimizes the cost shift to business.”

We disagree that Medicaid expansion is some kind of panacea, but that’s an issue for another day.

Today, I just point out that IACI is now arguing against itself. In 2012 and 2013, the organization said state control was paramount. That keeping the federal government out of Idaho health care necessitated the creation of a state insurance exchange. Less than a year later, IACI proposes lawmakers shelve the Idaho-run county health care program in support of a program run by bureaucrats in Washington, D.C. IACI wants to follow Arkansas’ path, go on bended knee and ask federal authorities for permission to operate expanded government health care the way another state is doing it.
I’m not suggesting that the increasingly expensive Idaho program is the right approach, either. I think Idaho should advance charity care options to fill the gap for the working poor.

But I can’t help but wonder about this rather large IACI inconsistency, and how IACI and lawmakers will resolve it. I also wonder if the oversized influence of Big Medicine on IACIs’ board—hospitals and insurance companies—is playing a part in the organization’s approach to public policy.