BOISE, Idaho (AP) — Gov. C.L. "Butch" Otter and the Legislature should broaden Idaho's Medicaid program to cover more than 100,000 additional low-income residents, but insist on tying the expansion to a benefit program that improves care, boosts personal accountability and reduces costs.
That was Friday's unanimous recommendation from a 15-person panel that's met since early summer to analyze costs and benefits of expanding Medicaid eligibility to cover people up to 138 percent of the federal poverty line. It's a key provision of President Barack Obama's health insurance overhaul, but one the U.S. Supreme Court left up to states to decide.
A Seattle-based actuarial firm told the group before it voted Friday that Idaho will save $6.5 million through 2024 if it expands Medicaid eligibility — and suffer costs of $284 million by rejecting it.
That's because nearly all of the costs of covering people newly eligible for Medicaid — mainly low-income adults without children at home — would be borne by the federal government. Rejecting expansion, by contrast, would mean state and county property taxpayers would likely simply continue funding Idaho's existing Catastrophic Health Care program that's due to run $61 million in 2014 to cover the indigent population's medical bills.
"The county indigent program has run its course," said Dan Chadwick, executive director and lobbyist for the Idaho Association of Counties and a panelist. "It does not work. It's become administratively and financially unsustainable."
The group's members, including doctors, hospital and medical association lobbyists, and representatives from Idaho businesses, said any expansion of Medicaid can't be merely a blank check to continue the programs of the past.
Rather, it should be tied to creating a benefit program for the newly covered that promotes personal responsibility — and reworks a medical culture where low-income patients and medical providers have too few incentives to reduce costs, improve care and boost the health of the working poor.
"If we don't do this, we do cripple Idaho, in many ways," said Ted Epperly, a Boise medical doctor and director of the Family Medicine Residency Program in Idaho.
In July, the U.S. Supreme Court upheld the constitutionality of Obama's Patient Protection and Affordable Care Act. Under the law, Washington will pay 100 percent of the costs of expanding Medicaid from 2014 to 2016; between 2017 and 2020, the federal share will decrease to 90 percent and the states' contribution would rise in stages to 10 percent.
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