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It was always a question for me when the House would have the guts to actually kill the Medicaid budget. Every year it would sneak though by 5-10 votes. This year, they actually killed it.

Lead by their wise Speaker, Mike Moyle, just over half the House Representatives wished away health insurance for Idahoans in poverty. It’s like spanking your stepson. What is your point? Other than to demonstrate your authority, or maybe your lack of generosity, or maybe your fealty to the Freedom Foundation?

Make no mistake, Medicaid is a Federal/State health insurance program for low-income people. The trouble is, Wayne Hoffman and most Idaho Republicans think these low-income folks don’t deserve health insurance. I can just see their bluster.

“I have health insurance because I work for it!” They thump their proud, inflated chest. Yeah, you have a ¼ time, taxpayer funded job with full medical coverage, also at the taxpayer’s expense. This stepson sees some hypocrisy.

“I voted against the Medicaid budget because we must control the costs!” comes the other cry of outrage. Well, addressing that problem will take more than a simple no vote. Does the average Idaho Republican legislator know that Medicaid annually costs the taxpayer less per enrollee than their plush state health insurance benefit? Does even the best-informed Idaho Republican legislator know the main mechanism used to control Medicaid costs is to pay hospitals and doctors less? When you take your sick legislative runny nose to your doctor, the state Insurance pays that doctor about three times what the poor person’s Medicaid pays. Do you like that method of cost control? Then I can see why you might think a “no” vote would control Medicaid costs.

Controlling health insurance costs is more complicated than motivating a sullen teenage stepson. Slapping either won’t help. It takes a lot more work than that.

Make no mistake, what we are really talking about here is poverty. I can hear Wayne, and his “vote no” minions scream, “No, it’s about preserving the American Way! People should work for what they get!”

I ask you, Wayne, and House “No” voters, do you know anybody on Medicaid? Do they work? If they don’t, I’ll bet it’s because they are a child, pregnant, a young mother, or taking care of someone. All the Medicaid patients I see are working. But, unlike my three elected Representatives, Medicaid workers don’t get Blue Cross health insurance with their part-time or low pay full-time work. Not all employers are as generous as your voters are.

Don’t complain that they are wasting your taxpayer dollars with their ER visits for runny noses. Doctors’ offices refuse to see Medicaid, where the care would be a third of the cost. Medicaid patients often have the ER as their only choice for care. Doctor’s offices refuse because you, fully insured legislator, have budgeted to pay doctors at a third of the price of what your Blue Cross Special plan pays them.

So, the House finally pulled the trigger and killed the multi-billion-dollar Medicaid budget. And what fiscally responsible substitute solution did they then come up with? The new budget looks a lot cheaper for this year, but there will be a $150M supplemental next year. Kick it down the road.

Nothing wrong with a little posturing, I guess. Maybe that’s all it’s about. Stepsons know posturing when they see it.

I’m going to relent here. There is a plan in the works to study “managed care” as a plan for controlling Medicaid costs. If anybody had been paying attention, they’d have seen the weak results many other states have had with this. I give the legislature a C- for the effort. It’s a mystery to me why Medicaid gets the slapped face, when private insurance costs have beat inflation year over year. Who’s driving this bus?

It’s pretty clear the Idaho Legislature doesn’t have their hands on the wheel.



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