Concerns over the economic impact of a possible expansion of the federal Medicaid welfare program and a proposal to circumvent the Legislature for the sake of bringing the expansion proposals to fruition took center stage Thursday, as Gov. Butch Otter's Medicaid expansion task force met at the Capitol.

After approximately six hours of presentations and discussions, the task force voted 10 to 3 to recommend that Otter pursue a plan to expand the federal Medicaid welfare program in Idaho.
Near the end of the day's proceedings, House Majority Leader Mike Moyle, R-Star, a task force member, told the other task force members "I feel like I'm at the Alamo. I haven't said much today, but I've got to say some things now."

"The Legislature is not going to approve an expansion plan," Moyle stated. "We're calling this a 'Medicaid redesign' meeting, but we're not taking about redesigning anything, we're talking about expanding something. If you're just going to vote to recommend an expansion plan, then let’s vote so I can get out of here and get back on my combine and get my work done. But I'm telling you the governor has already hedged on expansion, the Legislature has hedged and based on the political realities that we know today, the Legislature won't approve what you're going to recommend."

After Moyle's remarks, task force member Dr. Ted Epperly suggested that the Legislature should be taken out of the equation. "If the Legislature won't move on what I believe and what this group believes is the right thing to do, then perhaps the Legislature needs to be cut out of the process," he declared.

An advocate for expanding the welfare program, Epperly said that "we're talking about people’s lives here," then turning to Moyle stated, "maybe you and the Legislature needs to be cut out of this process. Perhaps we need a statewide initiative, and we'll take this directly to the people of the state of Idaho. We'll provide them with an educative process to further inform them on the issue."

"Fun stuff," Moyle replied. "I actually think that's a good idea though, the educational component, if you can get people more educated on this issue."

The "expansion" to which the task force members referred is an offer made by President Barack Obama's administration to the individual states. If a state will expand its roster of Medicaid welfare recipients by lowering eligibility requirements, the administration will reimburse the state for the expansion costs during the first few years of the implementation.

Opponents of the proposal argue that expanding a welfare program creates more government dependency; that the Idaho state government could become financially liable for the increased welfare recipients if the federal government reduced its funding for the program; and that it is unwise for Idaho to increase its reliance on the highly debt-ridden federal government.

Supporters of expanding the federal welfare program in Idaho maintain that Idaho can't afford to refuse the influx of more federal dollars in to the state, and that expanding the state's Medicaid roster is a compassionate and necessary thing to do.

During the day's discussion, task force members began crafting a list of what they believe are the "pros” and "cons" of four specific indigent health care plans that were under consideration. Among the plans, Option 1 would keep the state's current indigent health care plan in place whereby services are funded with state and county tax dollars; Option 2 would use federal dollars to purchase private insurance for low income individuals through the state's Obamacare insurance exchange; Option 3 would give low income individuals memberships in what are known as "direct primary care" health plans; and Option 4, the one the task force agreed to recommend to Otter, proposes to expand Medicaid under the proposals of the Obama administration.

Task force Chair Corey Surber of Saint Alphonsus Health System attempted to lead the group in a process of narrowing the number of options up for consideration, asking if any should be removed from the list. Epperly, however, interrupted the process and motioned that there be a vote on the Medicaid expansion option, and the motion prevailed.

"If we don't do this expansion, there will be more deaths in the state," Steve Peterson, professor of economics at University of Idaho stated earlier in the day's task force meeting. "We'll also see a decline in productivity, as workers will have to go without health care," he told the task force.

Peterson, who described himself as a "regional economist," noted that for the past 20 years he has been tracking industries within the state and their economic impact. He said "almost any type of economic activity that brings large sums of money into the state is beneficial to the economy."
Peterson also told the group that if Idaho does not accept the federal government's offer of more federal dollars, then the state's economy will be harmed. Claiming that the federal welfare program is more beneficial to Idaho's economy than certain commercial business enterprises, he noted that, according to his research, federal Medicaid dollars from Washington add more tax revenues and more jobs to the state's economy than do wheat sales made by Idaho farmers.

"I appreciate the presentation, but I have concerns and a question," responded Sen. Steve Thayn, R-Emmett, a task force member. "I understand that the infusion of a large sum of money creates economic growth in the short run, but I am concerned about the long-term sustainability of this plan. This is based on the consumption theory of economic growth, the notion that the more we consume the more prosperous we become. But prosperity is ultimately based on productivity, not consumption."

Thayn then asked Peterson "I am curious what kind of work our current Medicaid recipients do. Sometimes federal welfare programs produce dependency, so I'm wondering, have you researched how many Medicaid recipients work?"

"No, I have not," Peterson replied.

"We've already discussed this," interjected Susie Pouliot, a member of Otter's task force who works with the Idaho Medical Association. "We already got the details on that from Leavitt Partners and they told us that two-thirds of these people that would be served by the expansion program are working."
Leavitt Partners is a Utah-based consulting firm that advises state governments on how to expand government-funded health care programs. The group previously advised Otter's Medicaid task force, as well as the governor's Obamacare insurance exchange task force back in 2012.

After the interaction among Thayn, Pouliot and Peterson, several members of the audience requested to speak and reaffirm Pouliot's assertion that Medicaid recipients work for a living. Epperly said that Thayn had made an "unfair characterization" of Medicaid recipients, and stated that "an overwhelming majority of my Medicaid patients work."

The only three members of Otter's task force to oppose the recommendation of Medicaid expansion were the three legislative appointees: Thayn, Moyle, and Rep. Tom Loertscher, R-Iona.

An email to Otter's office seeking comment on Epperly's suggestion of taking the Legislature out of the process was not returned.