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Governor and the working poor

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The Governor’s proposed plan to avoid recognizing the Affordable Care Act remedy for Idaho’s working poor, as revealed in last Saturday’s Statesman, is just plain dumb.

He cannot seriously expect anybody to believe in it. Further, as stories of needless deaths and suffering from lack of affordable health care continue to mount, the Governor’s continued obstinacy to expanding Medicaid is just plain cruel.

The problem is how to provide adequate health coverage for a defined class of Idaho’s working poor, meaning those who do not receive health care through their employment, do not earn enough to qualify for subsidized private insurance from the state exchange, cannot depend upon a parent or spouse for health care coverage, and who earn too much to qualify for Medicaid under existing eligibility requirements. In Idaho there are approximately 78,000 individuals who fall into this category and have therefore remained uninsured. Two solutions are on the horizon.

Option A is to expand Medicaid to cover this defined class. This obvious solution is the intended implementation of the ACA. Federal funds to cover ten years of expanded Medicaid benefits are already built into the Act, so the cost to the state to accomplish and maintain the expansion is exactly zero. The estimated return in federal health benefits paid on behalf of the working poor recipients would be approximately $70 million per year. All that is required to fully implement the Act is state approval.

Option B is to continue the status quo with the addition of the Governor’s proposed care plan. This plan would cover some doctor’s visits for preventive care only, but would not provide coverage for labs, diagnostics, hospital care, prescription coverage, or follow up. Emergency care would still be under county indigency programs. Non-emergency hospitalization and surgery is not covered; there is no coverage for acute outpatient, non-emergency diagnostics, nor any follow-up care.

This means for example, that most cancer, cardiac and diabetic care would not be covered except for emergency flare-ups. To get any kind of follow up care, the circumstances have to qualify as a catastrophic disease or condition. The young woman who died in Idaho Falls from untreated asthma would still be uninsured under the Governor’s status quo plan. Everyone, even the Republicans who were recently quoted, acknowledged that the addition of the new plan to the existing hodge-podge of the status quo would be inadequate.

The cost of this new plan would be at least $30 million per year. In addition, the cost to the counties for indigent emergency care is over $30 million per year, and the cost to the state for catastrophic health care is over $35 million per year. Since the Medicaid expansion would essentially replace all of these status quo resources, these costs to the state and counties, approaching $100 million every year, could be almost completely eliminated.

On the pure numbers, Idaho has already lost in excess of $250 million over the initial two years of the ACA in state and county costs that could have been avoided and federal benefits that would have been paid if Medicaid had been expanded when the ACA was first implemented. Unnecessary deaths sustained by reason of inadequate health care in Idaho – which now are centered upon the 78,000 uninsured – have been estimated at 124 deaths per year.

It is pure sophistry to argue that there is some advantage to turning away close to $70 million per year in federally funded health care benefits for the poorest among us, plus wasting a combined $100 million per year of our own taxpayer money that could be saved, just to maintain a half-baked patchwork of admittedly inadequate state based programs. When the unnecessary death toll is measured against amounts of money we are flushing down the toilet every year, the right wing’s political objections to expanding Medicaid become the height of Luddite ignorance.

Even if the Republicans pull all their rabbits out of all their hats nationally in the elections of 2016, no thinking politician expects the ACA to be repealed outright; too much of it has become too ingrained in too many lives to imagine a U-turn now. With expanded Medicaid under the ACA now in place in 30 of our 50 states, there is no political chance that it could be abandoned in 2017. As even the tightest fisted Republican must acknowledge, adequate coverage for the very poorest among us is a legitimate government function that will be retained.

Given all of this, and whether one is a flaming liberal Democrat, a rock ribbed Libertarian or a teapot Conservative, money is money is money. Approving the Medicaid expansion will solve the problem with Idaho’s working poor, eliminate the wretched consequences of inadequate health coverage, and bring about a potential return to the state, in terms of immediate cost avoidance, potential cost reductions and fund savings at the state and county level, together with inflow of federal dollars for benefits paid to the working poor, of close to $165 million per year.

What can the Guv possibly be thinking?

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