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Posts published in “Day: August 29, 2019”

Waiver Season II


Harvest is well along here on the Palouse, tomatoes are ripe, and it’s the second season for waivers thanks to our state leaders. The open comment period for this round began last Friday and runs through Sept 22nd; you can read about commenting here.

We haven’t heard any response from the Trump administration on the first waiver application, “Idaho Coverage Choice”. That one would allow folks on the Idaho Exchange to choose to “keep their insurance”. That was submitted back in mid-July. It would add to our expanding federal budget deficit. I can’t see how it will be approved. I’m waiting for a tweet.

But the current waiver application has to do with the “work requirements” the legislature added and the Governor signed.

I’m all for helping, indeed expecting folks to climb out of poverty, and a good paying job is one honest way to do it. But the requirements for reporting and maintaining eligibility for health insurance have proven difficult for many states to implement. In Arkansas 18,000 folks got kicked off the rolls just because they couldn’t (or didn’t) file timely reports. I would hope Idaho could do better. But keep in mind, doing better costs more money. Do you want to grow government to keep nudging people to get to work?

Montana did it right. They tied Medicaid applicants to job training and work openings through their Department of Labor. It didn’t add any bureaucracy to their system, but boosted employment.

One of the blessings of being in a conservative state is we can learn from early-adopters mistakes.

Kentucky’s efforts to add work requirements were initially approved by the Trump administration but then thrown out twice by a Federal Court; same with New Hampshire. There are currently six states with Trump-approved Medicaid work requirements, but not enacted yet. I suspect Idaho will join this group. And then we will send our Attorney General to defend a lawsuit in Federal Court. Our tax dollars would be better spent helping the working poor, not paying lawyers.

One of the dirty little secrets of work and Medicaid is that there are lots of folks working even full time who would still be eligible for Medicaid. It’s because their employer doesn’t offer health insurance and their wages are so low. There are currently in the US over 5 million workers (35% of adult Medicaid enrollees) on Medicaid. They are janitors, food service, construction, hospital, retail workers. But not in Idaho; up until Medicaid Expansion passed, able-bodied adults without children were not eligible for Medicaid.

In Idaho, where our wages are so low, the Department of Health and Welfare estimates 60% of the newly eligible Medicaid population would be working the equivalent of full time. Keep in mind, Idaho’s unemployment is rock bottom.

So, this waiver proposal would set up reporting requirements. We saw what that did in Arkansas. Somebody forgets to file their monthly work report, falls off a ladder, goes to the ER, and who’s paying the bill then? Yup, the taxpayer pays, and our costly county Indigent Program and state Catastrophic fund pony up.

It makes sense to expect good behavior from folks getting public support. When I first was running for office I met with a group of union workers at the local. They didn’t seem too keen to see a Democrat. I asked them what was most important to them. One guy offered, “Why don’t we drug test people on Welfare?” I told him I’d look into it since it made some sense. Some states have done this. It turned out the expensive tests proved drug use in applicants for assistance was less than a third of the general population. And states paid out millions to deny benefits to less than 1% of applicants.

If we want folks to act responsibly, we should do so with our dear tax dollars.