Medicaid expansion: One issue is how much trust to place in federal promises

Medicaid expansion: One issue is how much trust to place in federal promises

by
Idaho Freedom Foundation staff
August 28, 2013
Idaho Freedom Foundation staff
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August 28, 2013
[post_thumbnail] Russ Hendricks, director of government affairs for Farm Bureau of Idaho, says Medicaid expansion promises to alleviate the costs of the indigent program for county government, but that trusting the federal government is another issue.

As an end-of-the-year deadline nears for the Obama administration’s Medicaid expansion offer to the states, groups and individuals across Idaho are weighing in with their official positions on the idea.

“The expansion of the Medicaid program is certainly not inevitable,” said Steve Ackerman, an independent industry analyst and adjunct professor at College of Idaho in Caldwell. “In fact, there are plenty of good reasons to not do this,” he told IdahoReporter.com.

Begun in 1965, the Medicaid program provides certain health care services to individuals and families with low incomes and limited resources. Financed with a combination of federal and state tax revenues, the expanding costs of Medicaid have in recent years become a topic of growing concern among the individual states, despite the eligibility of the program being based on a variety of means testing processes.

A key element of President Barack Obama’s Affordable Care Act (Obamacare) law was to have mandated that the individual states reduce eligibility requirements for Medicaid and expand the number of participants in their respective programs. However, the United States Supreme Court overturned that component of the Obamacare law, so expansion of Medicaid is now left as an elective choice for each individual state.

After that Supreme Court ruling last year, the Obama administration presented the individual state governments with a revised proposal: Expand Medicaid eligibility during the calendar year 2013 and the federal government will pay the costs of the expansion for the first three years.

In January of this year, Gov. Butch Otter Otter noted in his State of the State address his belief that Idaho’s Medicaid program is “broken,” but also stated that he did not intend to seek expansion of the program during this calendar year. Despite his expressed intentions, a legislative effort to expand Medicaid was undertaken in the Idaho House in March by Rep. Tom Loertscher, R-Iona.

While Loertscher’s legislation failed to get traction, the task force that Otter assembled to study the issue of Medicaid expansion unanimously recommended in March that Otter take the federal government’s offer and that, in its view, the state could save anywhere from $44 million to $100 million for each of the first three years of the Medicaid expansion.

But the notion that the Idaho state government would “save” money as Idahoans become more dependent on a federal entitlement program is a questionable assumption for Ackerman, who believes that the “offer” of the federal government is not necessarily a good one.

“Today the federal government funds about 74 percent of Medicaid in Idaho and if we take the expansion offer, that percentage will expand,” Ackerman said. “But the population of Idaho is expected to grow over the next 10 years. Combine this with the fact that the federal government is proposing to expand consumption of Medicaid and it begs the question, can the federal government really afford to promise all these things to us?”

Ackerman is not the only Idahoan who is skeptical of the promises of the Medicaid expansion plan.

“Medicaid promises to relieve the county governments of the cost of indigent care,” said Russ Hendricks, director of government affairs for the Idaho Farm Bureau. “But that's assuming that we can take those in our federal government at their word. Our members are concerned that Medicaid expansion will not be good for the citizens of Idaho, and their biggest concern is that they really don’t trust the promises of their federal government.”

He continued: “As we see the rollout of Obamacare, we observe that many components of it are happening in exactly the opposite way that they were promised. For example, Obamacare was supposed to reduce health insurance costs for families and households, yet prices are rising dramatically even as Obamacare is phased in. We don’t trust our federal government on this, and we oppose the Medicaid expansion idea.”

Of Medicaid expansion, Ackerman noted that there are no guarantees as to what percentage of the program’s costs will be paid by the federal government after the initial three-year period of expansion.

“Idaho is poised for population growth,” he told IdahoReporter.com. “Some health care analytics are projecting that our population may expand by as much as 50 percent. If the federal government even wanted to pay for all these additional Medicaid recipients in our state, the only way the government could contain the cost of it would be to scale back the health care services that are provided.”

He noted that in 2009, the U.S. Preventative Services Task Force, a medical experts’ panel that advises the U.S. federal government on Obamacare implementation, published a recommendation that women should postpone mammograms until the age of 50, a complete contradiction to private organizations like the Susan G. Komen Breast Cancer Foundation that advises women to begin receiving the exams in their mid-30s. “That was an effort toward health care rationing,” Ackerman explained, “and we’ll see more efforts at rationing as more people become dependent on Medicaid.”

If Medicaid is to expand in Idaho, such expansion would need to be authorized by the Legislature. When asked in May if the governor intends to call the Legislature in to special session to authorize an expansion of the program before the Obama administration’s year-end deadline, Otter spokesperson Jon Hanian would only say that “the governor will continue to include the Legislature in the process.”

A complete discussion with Ackerman can be heard HERE.

Note: Steve Ackerman is a member of the board of scholars for the Idaho Freedom Foundation. IdahoReporter.com is published by the Idaho Freedom Foundation.

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