Idaho’s Proposition 2 would expand Medicaid in one of the most Republican states

Oct. 30--Jenenne Newbre knew something was horribly wrong when she started getting debilitating headaches and had trouble concentrating.

But without health insurance, the Moscow, Idaho, resident found it hard to get in to see a doctor. During those three years, the tumor in her pituitary gland grew.

Newbre, 48, described what it was like to "live in the Medicaid gap" last week at a rally to expand health insurance in Idaho for low-income adults.

"I personally understand the impact," said Newbre, who eventually got treatment for the tumor, but still has related health issues. "I was very sick. I was turned away" from care.

About 62,000 Idaho residents fall into the Medicaid gap. They earn too much to qualify for Medicaid -- the federal government's health program for the poor -- but their incomes are too low to qualify for subsidies to help pay for private insurance under the Affordable Care Act.

Newbre's husband, Tom, works full-time. She had a part-time accounting job and was attending the University of Idaho when the tumor's symptoms first appeared. The couple supports Proposition 2, which would expand Medicaid in the state.

Idaho is one of four Republican states where voter initiatives to expand Medicaid are on the Nov. 6 ballot.

In Idaho, Nebraska and Utah, voters will cast ballots on measures to expand Medicaid coverage to people below 138 percent of the federal poverty level -- individuals earning less than $17,000 a year or a family of three making less than $29,000.

In Montana, voters will decide whether to eliminate a June 2019 sunset on Medicaid expansion and whether to raise tobacco taxes to pay the state's share of expansion costs.

Thirty-three other states, including Washington, have already adopted Medicaid expansion. It was a crucial component of the Affordable Care Act's strategy to provide health insurance for low-income adults, but some states chose not to enact it.

After Idaho's Legislature turned it down, voters gathered enough signatures to put it on the ballot.

Proposition 2 appears to have strong support in the Gem state. About 66 percent of voters favored it in a poll released in May by Idahoans for Healthcare, which is leading the campaign to pass the initiative. Recent poll results from Idaho Politics Weekly put support at 70 percent.

Members of the national media sometimes ask Emily Strizich, co-chair of Idahoans for Healthcare campaign, if Republicans will vote for the initiative.

"This is Idaho," she tells them. If Republicans don't support the initiative in one of the country's reddest states, it won't pass, she said.

Strizich is a pediatric occupational therapist from Moscow with a progressive grassroots background. Idahoans for Healthcare's other co-chair is state Rep. Christy Perry, R-Nampa, who is the co-owner of a gun store.

People are separating "politics from responsible policy that will dramatically improve people's lives," Strizich said.

Since neighboring Washington expanded Medicaid, the rates of uninsured dropped from 14 percent to less than 6 percent. More state residents are getting preventative care, early diagnoses and are able to afford their prescriptions, according to the Washington Health Care Authority.

In Idaho, thousands of people have signed the "Yes on Prop 2" camper, which Strizich and her husband Garrett brought to last week's rally in Moscow. The couple lived in the 1977 Dodge Tioga camper one summer and have since repurposed it for the campaign.

"We wanted something eye-catching that people wouldn't take too seriously, but would be a good conversation starter," Emily Strizich said.

The camper has appeared at about 100 campaign rallies, although "we try to keep it within the 70-mile radius for towing" covered by the insurance policy, she said.

Both political parties represented at rally

The Moscow rally drew politicians from both parties. Among them was Bill Goesling, a Republican candidate for state representative in Latah and Benewah counties. He supports Medicaid expansion, and when he knocks on doors in the rural district, he said most voters tell him they do, too.

"It's common sense," said Goesling, a retired financial planner. People who can't access doctors for regular health care end up in the emergency room, where treatment costs are significantly higher, he said.

Goesling, a Navy veteran, also said he wants to ensure that vets have access to health insurance. About 3,900 Idaho residents "in the gap" are military veterans and another 1,200 uninsured are their dependents, he said.

"A healthy economy starts with healthy individuals," Goesling said. "I look at it as an investment in our future."

Medicaid expansion would return about $400 million in federal taxes to Idaho to pay for the expansion.

The state of Idaho would be responsible for 10 percent of medical claims from those insured under the Medicaid expansion, with the federal government picking up 90 percent of the cost.

The Idaho Department of Health and Welfare hired Milliman Inc., an actuarial firm, to calculate costs to the state. The report estimated that 91,000 Idaho residents could be eligible for care under Medicaid expansion by 2020. The expansion would cost the state about $45 million annually but would generate about $40 million in savings to state and local governments.

The savings would come from reduced indigent care costs paid by Idaho counties and the state. Idaho's prison system also would see savings, the report said. More offenders would be getting substance abuse treatment, making them less likely to commit new crimes, according to the report.

Over a 10-year span, the state would pay an estimated $105.1 million for Medicaid expansion after the savings are taken into account, the Milliman report said.

Supporters of Medicaid expansion also point to potential economic gains. A study by University of Idaho economist Steven Peterson said Medicaid expansion will create 5,000 new jobs and generate more than $20 million in new tax revenue annually.

Paulette Jordan, Idaho's Democratic candidate for governor, has made Medicaid expansion a centerpiece of her campaign. Brad Little, the Republican gubernatorial candidate, said he will abide by the wishes of Idaho voters.

But Medicaid expansion faces opposition from the Idaho Freedom Foundation, a libertarian think tank in Boise. The foundation calls Medicaid expansion a step toward "a complete government-run healthcare system" and says the costs to Idaho are likely to be higher than projected, based on other states' experiences.

In the five years after getting treatment for her tumor, Newbre said she's come a long way. She's on the board of directors at CHAS Health in Moscow, a nonprofit clinic that serves people regardless of their ability to pay.

Newbre credits CHAS Health for helping her get the MRI that revealed the tumor. She had surgery at Swedish Medical Center in Seattle and follow-up radiation.

Newbre hopes to finish her sociology degree at the University of Idaho and put it to use helping others.

"I'd like to be an advocate for people like me who are stuck in an endless rut because of their health care," she said. "I want to help other people like I've been helped."

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