[Vision2020] More on HCA & Idaho

[Ron Force]

If Wasden wins health care suit, Idaho loses
Marty Trillhaase
March 28, 2010
If Idaho Attorney General Lawrence Wasden wins his health care 
lawsuit against the federal government, you will lose millions of 
dollars.
That's contrary to the argument Wasden and a dozen other 
attorneys general are making to throw out the Obama health care reform 
package. Of course, the primary one is constitutional: Does the federal 
government have the power to compel citizens to purchase health 
insurance? Most legal scholars say it does under the Supremacy Clause.
Tucked within Wasden's challenge is this claim: By expanding 
Medicaid coverage to working poor adults, the feds are inflicting 
billions of unfunded mandates on the states. That's because the states 
pick up a share of those costs and the federal government provides a 
match.
No one in Idaho government knows any such thing. The Department 
of Health and Welfare hasn't analyzed how health care reform affects the state budget. Neither has Wasden's office. Instead, Idaho is 
piggybacking Florida's health care reform lawsuit. Florida's case is 
where the claim about billions in unfunded mandates originates.
But Idaho isn't Florida. This is a low-wage state. It operates a 
Medicaid program that, while generous in its coverage of children, is 
extremely stingy when it comes to helping able-bodied adults.
So federal health care expansion is a huge windfall, worth at 
least $380 million per year to Idaho.
That's based on an estimate the Urban Institute prepared for the 
Lewiston Tribune:
l Idaho has about 106,000 adults who would become eligible for 
Medicaid beginning in 2014. For two years, the federal government will 
pay 100 percent of these new costs. After that, the state picks up 5 
percent and then the state match slowly rises to 10 percent by 2020, 
where it remains. That's one third the amount Idaho typically  pays for 
people currently enrolled in Medicaid.
l Another 75,500 people - mostly children - are eligible for 
Medicaid today but don't enroll. Many already have private insurance, 
but about 25,600 have no coverage of any kind.
Based on its modeling of employer and household choices 
elsewhere, the Urban Institute expects 82,000 people will be added to 
Idaho's Medicaid program once the changes launched in 2014 are fully 
phased in. It estimates the federal government will provide about $221 
million to cover their costs. The state's share eventually will come to 
$20 million a year. But before you scream "unfunded mandate," don't 
forget Idaho already pays the health bills of medically indigent people 
to the tune of $46 million. That program's costs spiked 30 percent last 
year, but even in good times the state must add 9 percent a year to its 
budget.
If Medicaid expansion reduces those costs by even half, the state would be money ahead.
l It's estimated 70,000 Idahoans will get federal subsidies to 
purchase policies through the health insurance exchanges created by the 
act. The average subsidy in Idaho will come to about $2,200. Based on 
the bill signed into law Tuesday, Idaho was to receive $158 million a 
year in these subsidies. But under the changes in the budget 
reconciliation act completed Thursday, the Urban Institute says the 
subsidy dollars coming into the state actually could be higher.
All told, that will mean a return of more than $18.50 for every 
dollar Idaho puts into the program. That's a huge infusion of money into Idaho's health care system, which would ripple throughout the economy. 
This says nothing of the benefits of insuring - and providing 
preventive care - to more than 150,000 Idahoans who today go without.
Such an accomplishment has a value far beyond dollars and cents. - M.T.


      
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