Opinion: Improving Medicaid expansion

In 2018, over 60% of Idahoans voted to support Medicaid expansion. Today, all four Medicaid programs serve almost 450,000 of our friends and neighbors. However, during the public health emergency, the Department of Health and Welfare didn’t have the option to manage eligibility and remove folks who no longer qualified for the program.

DHW estimates that roughly 150,000 people no longer qualify.

The end of the public health emergency this year means DHW began notifying this group that eligibility checks will restart. DHW will also help people who no longer qualify to find new coverage on our health insurance exchange. Of the 150,000, the department expects roughly 60,000 may drop off the books and likely lead to reduced costs over time.

As vice-chair of the House Health and Welfare Committee, I support our committee’s recommendation to continue analyzing Medicaid expansion. We need information from at least two years not impacted by COVID to measure the actual long-term costs and benefits to Idaho taxpayers. If we eliminate Medicaid expansion right now, it would cost taxpayers about $77 million or $10 million more than the state currently spends. The problem with those numbers is they don’t account for the other benefits to Idaho.

The federal share of Medicaid expansion is $9 for every $1 spent in state taxpayer funds. The $67.4 million in Medicaid costs to Idaho has brought in over $803 million of federal funds and an estimated $1.26 billion in economic activity. This investment has added over 9,000 new jobs, $700 plus million to the state’s gross domestic product and $14 million in sales tax revenue. I’ve talked to hospitals, and they shared that expansion produced over $100 million in savings because it eliminated our expensive, taxpayer-funded indigent program.

My favorite area of Medicaid expansion, behavioral health, generated over $360 million in new benefits and support for struggling Idahoans. But with long waiting lists, we know we still have work to do in mental health services. The loss of Medicaid expansion would hurt these programs and only increase the existing gaps. But how do we reduce the costs of expansion?

We’re working together to find alternatives. Some proposals include adopting managed care for Medicaid services, educating consumers on more efficient ways of using benefits and creating a pilot project of health centers that only see Medicaid participants. This last option would offer relief to our rural communities that often don’t have providers who can afford to serve Medicaid patients.

A campaign to educate and encourage consumers to seek routine care from a family physician instead of going to the emergency room could also make a difference. It’s estimated that around $6 million of Idaho’s share of funding goes to emergency rooms for issues that a family doctor could easily address. We also need to look at ways to help manage prescription drug costs.

I know there are things we can do to improve the value of this program for our state and for the people it serves. I’ve seen firsthand the difference it’s making in the lives of many in our communities. We owe it to taxpayers and the people who use the program to make it better for all involved to sustain it in the long term.