The term cognitive dissonance is applied to people who hold two conflicting beliefs in their heads at the same time. In no other public policy is this more apparent than how Idaho has handled the topic of Medicaid expansion to able-bodied adults in Idaho. Let’s provide some details:

Right out of the gate, in its first full year, Medicaid expansion cost 66% more than was originally appropriated. In the past five years, using estimates for Fiscal Year 2026 expenditures, program costs have tripled from the original cost projection. And when you review the numbers, it is quite clear that Medicaid expansion, not the core Medicaid program, has grown faster over the last five years. Don’t be persuaded by the slowing of the increase, because after tripling from original projections, it is still running at an unsustainable rate. Remember, core Medicaid was designed for poor children and people with disabilities. And Medicaid expansion added able-bodied adults, who should be working. Our view is that the case for repealing expansion is the only way to rein in the growth of the program, and the data bear that out. Idaho would save $1.3 billion, 90% of which is borrowed federal dollars. 

And there is another element to cognitive dissonance. On October 30, 2025, Governor Brad Little issued a press release with the following headline: “Idaho pursues $1 billion in new funding for rural healthcare access.” In other words, about $50 billion will be borrowed by the federal government, and Idaho will receive up to $1 billion of that to “Make rural America healthy again.” This implies that rural Americans are not healthy and that more federal health care spending is the answer. But the part of the press release that gets back to our original point is as follows:

WHEREAS, on July 4, 2025, President Donald J. Trump signed the One Big Beautiful Bill Act, P.L. 119-21, preventing a massive tax increase on all Americans, further cutting taxes, shrinking the size and scope of the federal government, and making historic investments in rural health with the creation of the Rural Health Transformation Program (RHTP);

Here we go again, shrinking the size and scope of the federal government while, at the same time, growing it. This is an endless circle that must be broken if we are ever to rein in federal deficit spending. And repealing Medicaid expansion to able-bodied adults is the logical first step.