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The politics of Idaho Medicaid


The most significant political question of the year in the Gem State may involve not the identity of its next governor or member of Congress but a question of policy – one with implications nationwide.

The political statistics web site FiveThirtyEight looked into it last month with an article headlined this way: “Does Medicaid expansion have a shot in a state as red as Idaho?”

It’s a live question. Many states around the country have expanded Medicaid availability under terms of the Affordable Care Act. (In Idaho, the estimate is that 78,000 people would get health insurance coverage who do not have it now.) Though the proposal has been vigorously pushed in Idaho for a half-dozen years, the legislature has refused to go along. Now, Idaho is one of four states (Utah is another) where activists are trying to use a ballot issue to change the law and expand access. If its advocates have luck there, more efforts may be tried elsewhere.

Ballot status isn’t yet assured in Idaho; elections officials have until July 5 to determine if the petition signatures turned in are enough to meet the tough ballot requirements. This is one of those “don’t count the unhatched chickens” kinds of situations, but the odds at present look good.

So suppose the proposal to expand Medicaid’s reach does hit the ballot: Will it pass?

You can make credible arguments either direction.

There is, after all, a political reason the Idaho Legislature hasn’t touched the proposal: A lot of Idahoans, especially in the Republican base, really hate the Affordable Care Act, and the expansion is a key part of it. A Boise State University survey in December turned up 58.8 percent opposed to the ACA compared to 35.2 percent in favor, though the “strong opposed” sub-category outnumbered the strongly in-favor group by well over two to one. (Nationally, the ACA is more popular than not.)

The question gets much more subtle and complicated when you get to Medicaid specifically, because Medicaid itself seems to be mostly popular, even in Idaho.

So what will Idaho think about expanding Medicaid: Might that idea be popular in Idaho even if the ACA still is not?

FiveThirtyEight, after evaluating all the significant numbers it found, suggested this: “Depends on how you ask them. In December of last year, a Boise State University poll of Idaho adults alerted respondents to the 78,000 low-income people who don’t have health insurance in Idaho, people who mostly fall in the Medicaid gap — too poor to qualify for subsidies on the health insurance marketplaces but too rich to qualify for Medicaid under current state rules. It did so, however, without ever mentioning the word Medicaid. It then asked, ‘Would you favor or oppose the governor and state legislature taking action to provide them with access to quality health care?’- Three-quarters of respondents said they would favor the move.”

And there was this: “In 2015, Dan Jones & Associates asked registered voters, “Do you support or oppose an expansion of federal Medicaid coverage in Idaho?” Sixty-one percent said they supported it. After the Republican-controlled Legislature declined to expand the program in 2016, 64 percent of Idahoans said they disagreed with the decision, including 49 percent of Republicans.”

If the issue is clearly and narrowly described when the campaign nears its end this fall, the odds of passage may be pretty good. If it is cast within a framework of the ACA, and of support for Trump or Obama, the result could be quite different.

As is so often the case, depends on how you define what’s in front of you.

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