Killing Medicaid expansion would cost Idahoans more, not less | Opinion

The House Health and Welfare Committee has introduced a bill to strip health insurance from tens of thousands of Idahoans.

Rep. Jordan Redman, R-Coeur d’Alene, on Monday introduced a bill to repeal Medicaid expansion, arguing costs are excessive, and the program is holding people back from reaching their “full potential,” as the Statesman’s Sarah Cutler reported.

If you would like costs to be even higher, Redman’s bill will do it. And if you really want to crush people’s potential, it’s a great way to do that, too.

The human potential argument, which claims without evidence that some unknown number people are working less in order to keep benefits, is particularly hollow.

The decision to repeal Medicaid expansion would be a decision to let hundreds more Idahoans die each year. That is the easily predictable effect supported by the available research on the association between Medicaid expansion specifically, as well as insurance coverage generally, and death rates.

Everyone is responsible for the predictable consequences of their actions. If lawmakers choose repeal, they will be choosing those deaths.

Redman is right to say Medicaid is expensive. The argument that those expenses can be avoided through repeal, however, is a fiction.

Repeal is running from a problem that you can’t avoid. It’s the idea that, when your check-engine light comes on, and you dread the bill from the mechanic, the problem can be solved by looking away and continuing down the road.

You’re still going to have a bill to pay in the end — and it will be bigger.

Why is Medicaid expensive? For one simple reason: American health care is extremely expensive. But Americans still pay far more for health care than do residents of similar wealthy nations.

Here’s why repealing Medicaid expansion won’t save money in the long run.

If someone has high blood pressure, society has several options, but none of them are free. The cheapest, generally, is if the person gets regular primary care visits and therefore catches the issue early. Then it can be treated with some combination of lifestyle change and inexpensive medication. This greatly reduces the long-term risk of stroke and heart attack, and it’s relatively cheap.

An alternative is to wait until a stroke or a heart attack, then provide life-saving surgery, extensive rehabilitation and possibly long-term hospitalization. This is a much worse outcome for the patient, and it’s much more expensive.

Either way, if the patient can’t cover the costs, you will.

You can pay through taxes to support government programs, payments to insurance companies or direct payments to providers. If an individual can’t pay for the care they need, providers roll the costs into what they charge other patients. So the question is only how you’ll pay, not if you’ll pay.

And it’s cheaper to do it through a government program. Government programs like Medicare and Medicaid significantly outperform the private sector in terms of cost control, both because of lower overhead and because they are more effective in negotiating down prices.

So the decision to eliminate Medicaid expansion is the decision to pay two dollars through your insurance premiums so you can save one dollar in taxes. In the end, you’re poorer, and a lot of people are sicker or dead.

This doesn’t mean there’s no need to address the problem, just that the solutions are hard — not easy little slogans like repeal Medicaid expansion.

An attempt at restraining costs was negotiated last year by Senate Health and Welfare chair Julie VanOrden, R-Pingree, the kind of serious policymaking veteran who is becoming unfortunately rare in the Capitol. It’s a highly imperfect bill, but it could have some positive effect on costs, particularly by switching to a managed care model. It’s just too early to observe the effects of the policy.

Lawmakers who are serious about health policy should observe the effects of that bill and search for the hard solutions that will work to contain costs.

That’s addressing the problem seriously. Redman’s bill is simply avoiding it.

Statesman editorials are the opinion of the Idaho Statesman’s editorial board. Board members are opinion editor Scott McIntosh, opinion writer Bryan Clark, editor Chadd Cripe, assistant editor Jim Keyser and community members John Hess, Debbie McCormick and Julie Yamamoto.

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