Last November, the voters of Idaho by 61 percent decided to extend Medicaid coverage to low-income adults who could not afford subsidized private health insurance.
Ever since, Idaho’s GOP lawmakers — who for six years refused to do anything to expand health coverage to the working poor — have offered this response:
We know best.
We can do it better.
We can do it cheaper.
We can be more precise.
Just let us do it.
How is that working out?
Last month, the Trump administration rejected the Legislature’s plan to offer some Medicaid beneficiaries — those earning between 100 percent and 138 percent of the federal poverty level — the option of remaining on subsidized insurance. Said the Centers for Medicare and Medicaid, private insurance would cost the federal government more than extending Medicaid to that population.
And while the Legislature’s efforts to impose work requirements on the Medicaid expansion population is proceeding through a public hearing process, the long-term prospects are in doubt. Last March, the federal courts stopped Arkansas and Kentucky from pursuing a work requirement. Before New Hampshire hit the pause button this summer because so many people were about to lose coverage, a federal judge stopped the program.
In any event, what Idaho lawmakers passed into law was just as severe as policies in those other states — and sometimes even more punitive:
l Swath of the population affected — Idaho’s work requirement applies to adults ages 19 through 59, which is about the same policy under way in Indiana. Kentucky and New Hampshire would impose it to people ages 19 through 64. But Arkansas experimented with those in the 30-to-49 age bracket and was planning to extend the rule to those as young as 19.
l Hours — Idaho would require people to prove they are working 80 hours a month, studying or otherwise occupied to get Medicaid. That’s in line with Arkansas and Kentucky, less than New Hampshire’s 100-hours-a-month mandate but far short of Indiana, where an incremental phase-in won’t reach 80 hours a month for almost another year.
l Penalties — Here, Idaho’s policy stands out as unusually harsh. Failure to certify compliance — even if the person is indeed employed — each and every month will result in loss of Medicaid coverage. New Hampshire also has a one-strike policy, but that state is more lenient toward allowing its people to come back into compliance. In Arkansas and Kentucky, it takes three months of botching the certification process — or simply not working — to lose coverage. Indiana says a person has to miss five months during a 12-month period before access to Medicaid is curtailed.
Even so, in some of those states people who were employed still were getting caught up in a bureaucracy and losing their benefits. Without access to prescriptions and ongoing care, some got sicker and could not continue working.
For instance, 18,164 of the 60,680 people subject to Arkansas’ work requirement lost health coverage. In New Hampshire, it looked like 16,637 of the 24,766 people affected by the rule were about to be cut off from benefits this summer.
Assuming the projections are correct, Idaho’s rule could eliminate 16,300 from getting Medicaid. And that estimate may be on the conservative side. In Arkansas and New Hamphire, the numbers of people who lost benefits were higher than expected.
Not only would that compromise their health, but it will cost taxpayers money.
Last spring, for instance, lawmakers said administering a work requirement would cost the state a minuscule amount —as little as $1.6 million. To implement this rule, Idaho will have to create new systems so people can report their hours. It also will have to devote additional staff time to keep track. Pursuing a strict one-strike policy seems like a recipe to generate more appeals and expand administrative workloads.
Every one of those 16,300 people who winds up in a health care crisis will turn to Idaho’s medically indigent program — placing a burden on local county property taxpayers and the state’s Catastrophic Health Care fund.
As noted, none of those states has embraced a policy as punitive as Idaho’s one-strike and you’re out. What makes lawmakers think courts would be more tolerant of Idaho’s even more severe system?
Add it up:
Idaho is trending toward being more draconian, more bureaucratic, more expensive and more litigious.
So much for improving upon the work of the voters. — M.T.