Oh, Medicaid expansion, Idaho Gov. Butch Otter just can’t quit you.
Time and time again, Otter just can’t quite seal the deal and fully opt out of more government health care here in Idaho.
In setting the agenda for the state in 2015, Otter, in his State of the State address, suggested he likes some ideas generated by his hand-picked Medicaid working group, which endorsed expansion just months ago.
Personal accountability, value-based service and co-pays must be part of Medicaid moving forward, the governor stressed in his address, delivered last week in the Capitol in Boise, and a press conference afterward.
Otter’s smoke signals continue to confuse onlookers, as the governor refuses to close the door on the idea of adding roughly another 100,000 Idahoans to the program. When asked by IdahoReporter.com if he would sign a Medicaid expansion bill if it arrived on his desk this year, the governor deflected.
“I’m saying at least those three things,” Otter said. “There will be some other things that come in that make the old Medicaid system more accountable. We need adjustments to the old system.”
After some pressing, Otter suggested lawmakers take a crack at the plan, but didn’t indicate what he wants them to do.
For Democrats, this serves as a victory, if a small one. “In the governor's address, he left the door open a crack for an alternative to the Indigent program and CAT (catastrophic care) fund in the payment of health care services for low income Idahoans,” wrote House Minority Leader John Rusche, D-Lewiston, in his weekly e-newsletter.
“Although most Republicans don't want to talk Medicaid, there is a real advantage in using what is available to us.”
There is some draw to Medicaid expansion. The state and counties could offload serious costs -- millions and millions annually -- to the federal government. That’s a huge carrot for some, including those who believe the new government spending would stimulate the Idaho economy and create jobs.
Otter’s State of the State wasn’t the only recent public event in which the governor just couldn’t give up on expansion. During a general election debate last year, Otter said the state “probably” wouldn’t expand Medicaid, but offered no concrete promises.
Just a crack, indeed.
One critic, Boise State University political science professor Scott Yenor, slammed the governor for giving in to the temptation of federal money. “It seems like he gives in to temptation,” Yenor said. “He didn’t seem to be for it or against. I take it that means he’s for it.”
Yenor warns the governor and lawmakers against falling for Medicaid expansion and the promise of new federal dollars because someone eventually must pay the bill for new spending.
“That always comes with great strings. You dont know the size of the strings and they become ropes,” Yenor said. “Nevertheless, it’s a dangling piece of funding he’s going to take because it’s free money for Idaho.”
Idaho’s budget already includes more money for Medicaid. If lawmakers adopt the governor’s wish list, or at least part of it, Idaho will spend another $26 million in state dollars on Medicaid next year.
The federal government will chip in an another $26 million, too, to bring total new Medicaid spending to more than $52 million.
The state’s already added more people to the system, too. Because Obamacare forces Americans to purchase health coverage or pay a penalty, some Idahoans came “out of the woodwork” to join the Medicaid system. These are residents who previously met Medicaid program requirements, but never signed up.
Otter said last week that number might be lower than expected, possibly just 45,000. Analysts suggested as many as 70,000 previously eligible Idahoans might join the Medicaid rolls.
Yenor, who sits on the Idaho Freedom Foundation Board of Scholars, admits he won’t be surprised if Otter takes the cash. “All of the incentives are there to allow it to continue,” the professor said of offloading costs to the federal government. “Who is there to complain?”
Another critic, Boise realtor and Tea Party leader Chad inman, believes he knows exactly what the governor will do.
“I think he’s going to follow the lead of the big business,” Inman said. “That’s what I heard him say.”
Idaho’s hospitals are certainly pressing for expansion, which would mean more revenue for them. The Idaho Hospital Association and the Idaho Association of Commerce and Industry, a lobbying heavyweight, want lawmakers to at least explore expansion.
A veteran lawmaker isn’t so sure Medicaid expansion can gain traction this year. Rep. Stephen Hartgen, R-Twin Falls, told IdahoReporter.com the plan might not have the votes it needs.
“I just don’t think it will pass the House,” Hartgen said.
Hartgen, in office since 2008, said the price tag might be too high and the federal government too untrustworthy for lawmakers to take the bait.
“We’re $18 trillion in debt,” Hartgen said. “In Idaho, I don’t think people want to add to that.”
The federal government offers to pay 100 percent of expenses for new enrollees covered under the expanded guidelines for three years, before dropping to a 90-10 split in 2019 and beyond.
Still, Hartgen says that’s not enough. “Wow, big deal,” the lawmaker said. “Three years goes by in a heartbeat when you’re in the federal government.”
He added that the state would have to either find funding for those 100,000 new enrollees should the federal government not follow through on its promises, or take health coverage away.
Note: The Idaho Freedom Foundation publishes IdahoReporter.com.