Idaho DOGE found an inefficient way to take away health insurance | Opinion

You can trace the roots of the latest push to kick Idahoans off of health insurance to a bunch of goofy memes in the mid-2010s.

People had fun putting cute pictures of dogs alongside broken English phrases like “many fast” or “very speed,” and they misspelled the word “dog” as “doge.” Around the same time, someone thought it would be funny to create a cryptocurrency based on those memes, Dogecoin.

Years later, ketamine-guzzling CEO-turned-Twitter-addict Elon Musk decided to campaign for President Donald Trump and was rewarded with largely unconstitutional free rein to start cutting where he liked in the federal government. He named the project after his favorite memecoin, and the Department of Government Efficiency (DOGE) was spawned.

And because we live in a ridiculous world, Idaho Republican leaders decided they had to create a copycat board of lawmakers. And last month, they recommended that Idaho eliminate Medicaid expansion.

If the Legislature follows this terrible advice, Idaho would give up one of the best returns on investment of any program it runs, cost everyone more out of pocket in the long run and kill a bunch of its citizens.

I concede that Idaho’s DOGE committee did find what at least gives the appearance of steps where efficiency gain may be possible. Maybe you can get rid of the Bingo-Raffle Advisory Board. Maybe Idaho doesn’t have enough of a honey industry to justify the Idaho Honey Commission.

But the Bingo-Raffle Advisory Board has no independent budget. The Idaho Honey Commission’s annual spending authority is less than $6,000. The commission optimistically estimated the effect of its recommendations at $300,000 per year in reduced spending — about 0.006% of the general fund budget.

Many efficient. Very savings.

What that is testimony to, above all, is that it’s actually quite hard to find efficiencies in state government operations. You could eliminate — or triple — these inefficiencies and no one could tell the difference. If your current state income tax bill was $1,000, eliminating the inefficiencies would save you $5.60 per year, a couple packs of gum these days.

Because it did not prove able to find many ways to make government significantly more efficient — to cut costs without people noticing the loss of services they rely on — the obvious thing for Idaho’s DOGE Committee to do would be to change its ideologically rooted view that government is a priori wasteful and inefficient. But one thing politicians rarely do is come to new beliefs in light of new evidence, particularly when it amounts to admitting failure.

Instead, last month the committee recommended taking away health insurance from tens of thousands of Idahoans. That would cut state general fund spending by over $90 million.

Finally, big-boy numbers.

Except that this step would be even worse from a pure fiscal standpoint.

According to numbers prepared by the Legislative Services Office for Rep. John Gannon, D-Boise, Medicaid expansion gets about $196 million from a drug rebate program that requires drug manufacturers to pay rebates to reduce the cost of drugs for Medicaid recipients. Take health insurance away from all those Idahoans, and that funding goes away too.

But the big blow would be the loss of federal funding — currently over $1 billion a year.

So the fiscal effects couldn’t be clearer: Giving up about $1.3 billion to save the $92 million put up by Idaho taxpayers. That’s the kind of efficiency that could put even Musk into the poorhouse someday.

This doesn’t include the other negative economic effects it would have. Idaho has a $130 billion economy. Eliminate Medicaid expansion, and you suck about 1% out of the state economy in a single year, the vast majority of it federal funding. What exactly happens could be complex, but it’s reasonable to expect that total income and economic output would be in the neighborhood of 1% lower than they would be with Medicaid expansion in place.

But the fiscal effects and economic aren’t what’s most important. What’s most important to remember is how many people the Legislature would kill if it repealed expansion.

One recent study found that Medicaid expansion was associated with about 12 fewer deaths per year per 100,000 residents. So a reasonable estimate is that repealing Medicaid expansion in Idaho would kill 244 people every year. That’s in the same neighborhood as the estimate given to lawmakers before Medicaid expansion.

That would be an unconscionable, wicked thing to do for the sake of a dumb meme and to cushion a bunch of politicians’ egos.

Bryan Clark is an opinion writer for the Idaho Statesman.

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