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Real work requirements and a sunset needed for Medicaid expansion

Real work requirements and a sunset needed for Medicaid expansion

Wayne Hoffman
February 22, 2019
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February 22, 2019

The House Health and Welfare Committee has voted against considering legislation to repeal Medicaid expansion or, at minimum, review the expansion before renewing it in a few years. Thus, it seems a Senate bill is the last remaining proposal to contain costs associated with providing free healthcare to thousands more Idahoans. But alas, that’s not true because Senate Bill 1100 is mostly vaporware.

Where it is substantive, the Senate bill gets healthcare policy wrong—in familiar ways.

The measure, still awaiting a hearing in the Senate, calls for the state Department of Health and Welfare to “inform Medicaid participants … of the department’s employment and training program and offer to such participants the opportunity to enroll in the program.” This is known as a “voluntary work requirement.” It gives cover to politicians who want to tell their constituents that they added a work requirement to Medicaid without pissing off the people who insist that the Legislature respect “the will of the people” when it comes to voters’ decision to expand Medicaid to able-bodied, childless adults.

Though Medicaid-expansion advocates fear that Idaho will join eight other states in adopting real work requirements that would kick people off of Medicaid if they don’t work, you won’t see advocates or expansion proponents attacking a plan to “inform participants” about the “opportunity” to volunteer for the program. According to the Foundation for Government Accountability, Wyoming and Nevada each expect around 100 adults will participate in their states’ voluntary employment and training programs. Utah’s voluntary program is expected to have no participants.

Actual work requirements aren’t a lot better, but still better. Idaho state officials estimate that adding work requirements to Medicaid expansion, and making those requirements similar to the ones used for Idaho’s food stamp program, would impact about 20,000 participants. This represents only some 20 percent of expansion enrollees.

Another problem with Senate Bill 1100, it would also have the state seek the federal government’s permission to start a new program wherein Idaho uses federal funds for some Medicaid-eligible Idahoans to buy private insurance. If that sounds a lot like a state version of Obamacare, it’s because it pretty much is. It was designed to unwind the federal control of healthcare from the national level, but the problem is that it resorts to the same insurance industry bailout and marketplace price interventions that doomed President Barack Obama’s signature policy, only this time failure would be administered in Boise instead of Washington, D.C.

Though probably not intended, the bill also weakens oversight of Medicaid expansion, telling the Legislature to wait until 2023 to discuss the program's continuation or repeal.

Before they drop a dollar into Medicaid expansion, lawmakers need to pass legislation that keeps Medicaid expansion from inflicting unlimited amounts of damage. A bill that contains actual, meaningful work requirements and requires the Legislature to reauthorize the program in a few years is the best way to balance what voters unwittingly asked for with protection for taxpayers and state programs likely to suffer when, not if, Medicaid expansion begins fiscally careening off the rails.

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