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Posts published in “Day: September 14, 2023”


I have watched the Idaho Freedom Foundation and their mouthpieces rant against Medicaid for years now. Rants can be fun, but honestly, there’s hard work to do.

I invite your shoulder to our shared grindstone. I believe managing health care costs is one of our generational tasks. Griping, ranting, finger pointing may fire up the crowd, but what we need are solutions.

First, we should make sure we know just what it is we are talking about. In case you haven’t noticed, rants can often focus on generalizations. We need some specifics.

Idaho Medicaid provides health insurance to low-income people and special needs, high cost, disabled folks. Does the fact that these folks are different than those who get insurance through their workplace make them more expensive?

So, let’s get grimy. Here come the filthy, greasy numbers.

Idaho numbers can and are parsed into easily compared numbers. The Per Member Per Month (PMPM) Idaho Medicaid cost for “basic plan”, meaning the low-income folks without special needs for FY2023 comes to $341.14. If you add in the total PMPM costs for the higher needs population (adults, $3103.54, children $1370.73) it comes to $2045.66. There’s a small group of very high needs folks in a “Coordinated Plan”, and they cost $2724.66 PMPM. The Medicaid expansion population is cheap at only $625.10 PMPM.

Per Member Per Month Idaho Medicaid Costs by Plan:

  • Basic Adult - $647.67
  • Basic Child - $281.74
  • Enhanced Adult - $3103.54
  • Enhanced Child - $1320.73
  • Coordinated - $2724.31
  • Expansion - $625.10

Add all these together and the PMPM for the total Idaho Medicaid population comes to $780.16.

What does the general working population pay for its health care costs, combined employer and insured expenses? In Idaho, for 2022 that came to $607.66.

Very few private insurers cover the severely disabled population. So then let’s compare the “Basic Medicaid” to private insurance costs.

  • PMPM Basic Idaho Medicaid Adults and Children - $341.14
  • PMPM Private Insurance - $607.66

Then let us consider administrative costs. Private insurers, since the Affordable HealthCare Act, are required to pay out 85% of their revenues for medical expenses. In other words, their administrative overhead (CEO compensation, care management costs, advertising, etc.) can only be 15% of their revenue.

How much does Idaho Medicaid suck off the top? Five Percent is estimated for FY 2024. In the past it’s been below 3%.

The goal of the Idaho Freedom Foundation is to decrease Medicaid enrollment. They must be really happy that the Department has kicked 150,000 folks off Medicaid in the past 12 months. During the pandemic the federal government prohibited any disenrollment, but the rolls have been cleaned up now. The vast majority of the folks lopped off couldn’t be contacted. We’ll hear about them when they get hauled into the ER by ambulance.

I guess it comes down to the fundamental question of whether you believe people should have health insurance or not. Maybe you think only people with “good” jobs should have insurance. Maybe you think only people who are “good citizens” should have insurance. Maybe you think insurance itself is evil, a “moral hazard” that promotes excessive use. If your goal is to control health care costs, all of these preconceptions have implications in the solution you will propose.

There is some amazing, good news I’ll bet you haven’t heard. The growth rate in Medicare (NOT Medicaid…they are different animals) spending has flattened since 2010. Nobody can really explain why. But the consequence is that in the last 13 years, since we didn’t keep up that killer growth rate, we have saved our future generations almost $4 TRILLION dollars.

We need to have honest, open conversations about health care costs. Maybe the big kerfuffle about Obamacare was the magic that flattened that curve. Let’s do that for Medicaid in Idaho.