The Great New England poet, Robert Frost penned a line appropriate for Idahoans to contemplate as we consider expanding Medicaid, “Two roads diverged in a wood and I – I took the one less traveled by, and that has made all the difference.”
Robert Frost was Poet laureate of Vermont, the state that recently pulled the plug on its plan to impose a single-payer health care system on its citizens. Democratic Governor Pete Shumlin killed the proposal, an idea he campaigned on, because the plan would have required the state to raise an extra $2.5 billion annually. The totality of Vermont’s state-level spending for all programs is about $2.7 billion. Funding this would have required steep increases in both payroll and income taxes something not palatable even in deeply blue Vermont.
Proponents of a single-payer system in the U.S. have often referred to it as Medicaid (or Medicare) for all; which brings us back to the Medicaid expansion proposal in Idaho. Unlike in Vermont, supporters of an Idaho Medicaid expansion claim because the federal government is picking up the bulk of the tab the state will benefit.
Let’s go back to our metaphor on the path we choose, because while it might start out smooth it will get rockier for Idahoans in the years to come. The federal percentage paid for the expansion will decline – by how much we can’t be sure. Already Congress is looking to revise downward the promise that the federal government take on 90 percent of the cost in perpetuity.
What’s more, adding participants to the Medicaid system will pressure the medical infrastructure and the ability of government to contain costs without rationing medical care. This final point is one of the reasons medical wait times have doubled in Canada’s Universal Health Care Single Payer system over the last two decades. More than 68 million Americans are on Medicaid.
Now is not the time for Idaho to go down the path of further Medicaid expansion.
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