Opting out of Medicaid – and its billion dollars?

How about this for a closing line: “In other words, in his zeal to strike a political blow again President Obama’s most important accomplishment, [Idaho Governor C.L. “Butch”] Otter has endangered the health of over more than 200,000 Idahoans and forced financial ruin upon his state.”

What? Could such a statement be justifiable?

On April 20, Otter vetoed the “son of nullification” bill (House Bill 298), which was aimed at blocking Idaho from going along with any provisions of the 2010 Affordable Care Act. His reason was not its near-certain unconstitutionality, but rather that the state might not be able to set up a health insurance exchange. Not to disappoint the backers of the bill, however, he issued an executive order saying that “No executive branch department, agency, institution or employee of the State” could take any action toward implementing the ACA.

Circle back to a letter dated February 8 from the Idaho Attorney General’s office, on the subject of ACA nullification. It cautioned about such an attempt’s “effect on existing and future Idaho participation in the Medicaid Program. As a purely voluntary program, Idaho’s refusal to comply with the expanded provisions within the PPACA could potentially result in Idaho exiting the program and losing the existent federal matching funds. This could create a situation where individuals presently covered would no longer be covered, yet still require medical treatment, which likely would be required to be provided for and paid for through some non-federal means. This situation, in turn, could create an intense burden on the State’s budget. In sum, the Legislature may wish to consider whether its adoption of RS 20315 has the practical and legal effect of opting Idaho out of Medicaid and its attendant federal funding.”

Good-bye as much as a billion dollars for treating the ill in Idaho. The choice presumably, unless a waiver were allowed (by Otter), would be to raise state taxes by a billion dollars or let about 223,000 people reliant on public health funding sicken and die. (Considering that this is Idaho 2011, which of the two scenarios would seem more probable?)

The national political web site ThinkProgress (the source of the quote up top) argued, “Otter’s executive order forbids state agencies from implementing “any provisions” of the ACA, and it provides that “[n]o executive branch department, agency, institution or employee of the State shall accept or expend federal funds to implement the provisions of the []ACA.” The reason why this is problematic is because, starting in 2014, the ACA requires states participating in the Medicaid program to offer health coverage to all persons under the age of 65 who earn up to 133% of the poverty rate. In return for expanding Medicaid, the federal government will provide each state with the lion’s share of the funds required to do so. Otter’s order forbids his state from complying with these new requirements to remain in the Medicaid program, and it also forbids Idaho from taking the federal funds that will allow it to pay for expanding Medicaid.”

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