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Waiver season

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It’s summer, so it’s time for wilderness hikes, river floats, stream fishing and reading Medicaid waiver applications.

Many don’t believe it, but the Federal government is our partner in Medicaid. It is a Federal law, but states have a say. Heck, if Idaho wanted to we could withdraw from the whole program. We could thumb our noses at the $1.8 Billion Federal dollars we get every year to provide care for our severely disabled, aged poor and pregnant women. Many legislators vote against the budget. In fact, Idaho House Republicans split evenly this year on approving the Medicaid budget. If they really don’t want to participate in the program I’d like to see them come out and vote to end the partnership. But they haven’t been so bold.

Instead, they asked our state agencies, the Department of Insurance and the Department of Health and Welfare to work to modify the plan approved by voters, simple Medicaid Expansion. These proposed modifications will need approval of the Trump Administration, and they will need to be lawful, that is, follow the law of the land. Of course, the Trump Administration could approve an unlawful waiver request. Then someone would need to sue to get a judge to interpret the legality.

The first waiver application is “Idaho Coverage Choice”. The DOI has closed their comment period, but now the DHW has learned they must apply for a waiver for this program also, so their comment period is open. This modification to Simple Medicaid Expansion would allow folks between 100-138% of the Federal Poverty Level who currently have health insurance through the exchange to choose: either enroll in Medicaid or “keep your insurance” on the Idaho Exchange. It is estimated this would affect about 18,000 Idahoans.

I’m all for giving people choices. But this program would be very costly to our federal government. If you read the reports from DOI and DHW they claim a “savings” for the budget. But the savings claimed are reduced tax credits and subsidies when people go OFF the exchange and enroll in Medicaid. Doesn’t it make sense that the more people we moved that direction, the more we would save?

Their own figures claim an average “cost” of tax credits and subsidies for exchange enrollees Per Member Per Month between $430-$802. But they also estimate the cost of enrollment in Medicaid PMPM would range $212-$496. It’s pretty clear to me this proposed waiver would not be budget neutral for taxpayers.

There is no mention of other costs to those who choose to “keep their insurance”, like deductibles, copays, out of network fees that insurance companies use to try to keep their costs down and reduce “overuse”. I guess that’s because it comes out of their own pockets.

Why would conservative Idaho Republicans want to offer people the freedom of choice of more costly health insurance on the taxpayers’ dime? If the real reason for this “Idaho Coverage Choice” plan is to save some enrollees on the exchange, effort would be better placed to make plans more affordable for folks above 200% FPL who buy insurance on the exchange. They are going uninsured in droves. Can’t blame them; the subsidy and tax credit tables need a big adjustment. But that would take a congress that wants to fix the Affordable Care Act. Republicans won’t go there and Democrats are too busy wanting to abolish private insurance or promote “Medicare for All”.

It’s no mystery why Medicaid health insurance is cheaper than private plans. Medicaid and Medicare set what they pay. Providers either take the low payment or refuse to participate. Private insurers are stuck negotiating with providers. Moreover, reducing costs reduces their cash flow.

I appreciate the Idaho legislature trying to make some innovative changes to the health payment system. But choice, in this case, is too expensive.

There are many more waivers coming. Stay tuned.
 

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