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We’re No. 1: Unfortunately Idaho led the way with single-payer health care

We’re No. 1: Unfortunately Idaho led the way with single-payer health care

Wayne Hoffman
June 20, 2014

Sometimes, when I speak to groups, I'll ask "which state pioneered the single-payer health care system long before Obamacare was even a wisp in the president's eye?"

Predictably, the answers from the audience include California, Massachusetts and Connecticut. I wish.

Actually, it's Idaho, which started a program decades ago in which the government pays the health care expenses of those who lack insurance and don't qualify for federal programs like Medicaid. The program starts with support of county taxpayers and then drags state taxpayers into the mix when costs exceed $11,000. Government-funded health care has been an albatross around the necks of taxpayers for decades.

If not for our expensive state-county funded health care system, Medicaid expansion—the next step in the implementation of Obamacare—would likely stand less of a chance.

But members of a state Medicaid task force meeting in Boise a few days ago are determined to make Medicaid expansion a reality. They're trying to adopt plans put forward in Arkansas and Indiana (or anywhere else for that matter) to get the state to accept supposedly free money from the federal government to extend Medicaid, largely to childless adults in Idaho.

Said Steve Millard of the Idaho Hospital Association, "We have a real opportunity here to expand Medicaid and to do it on the federal dime. That is good for Idaho, and my association is prepared to spend money on this to make it happen."

I'm still trying to figure out how expanding a failed government program, Medicaid, using money from an empty federal treasury, is good for Idaho.

Several lawmakers, still feeling the sting from having implemented the Obamacare insurance exchange in 2013, aren't looking forward to another fight in 2015.

“Medicaid expansion, as such, is not going to happen,” said Sen. Lee Heider, R-Twin Falls, chairman of the Senate Health and Welfare Committee. “People don’t want Medicaid expansion. We want the federal dollars, but what we need to do is get creative and come up with a different way to give all Idahoans something that they want. Requiring people to pay a co-pay is very reasonable.”

Supporters of Medicaid expansion will have you believe that they're not really expanding Medicaid per se, because they're creating a variation on the program that requires patients to pay a co-pay or some other state-driven change to the federal health care model. Don't believe it.

Experiences in Idaho and other states have shown how foolhardy that can be. States have long understood that the federal government won't allow them to deny care to people who won't pay even a nominal amount of money. Therefore, co-payments do little, if anything, to make Medicaid patients have so-called "skin in the game."

Other state-set parameters for Medicaid expansion have been slammed and rejected by the Obama administration, leaving states stuck with federally run health care and zero real control over implementation.

Idaho does have a problem with its single-payer government health care system, adopted decades ago. Substituting it with Obamacare won't make things better.

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