In March of 2010 the United States witnessed the first major health care reform since 1993 with the enactment of the Affordable Care Act (ACA). One of the provisions that were included in the ACA was states needed to expand eligibility requirements for Medicaid. However, Idaho decided not to expand Medicaid in part because Idaho is deeply conservative state and wanted little to do with ACA. On the other hand, many Idahoans’ did not agree with the decision not to expand Medicaid so they took on the arduous of getting the expansion on the ballot.
A recent study done by the University of Boise found that 71% of the population of Idaho was in favor of the expansion of Medicaid, with only 28% in disagreement (Young). With so much of the population wanting Medicaid expansion, should Idaho let political tribalism get in the way of expanding health insurance to its people? I believe legislators should not and that is why Idahoans should vote yes to enact thr program that expands healthcare to those who need it most, known on the ballot as Proposition 2, so the state can better protect and serve all of its citizens and the United States.
To really understand what Proposition 2 means for Idaho, you have to have a some background information on Medicaid, the ACA and how the ACA is tied to Medicaid. Medicaid was established in 1965 with the passing of the Social Security Act and is essentially a type of joint federally and state run insurance that can be used by people who meet certain poverty guidelines of all ages, pregnant women, children and those with disabilities. Medicaid is not fully funded by the federal government so states do pay about half of the cost of the program, so some states impose a 1-3% premium according to the qualifying persons income (Vestal, 2018). To put in another way, some people in certain states who qualify for Medicaid still are paying some out of pocket expenses to help pay for their coverage based on their income.
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Although some exceptions do apply when it comes to paying into the services like being severely disabled, which analysis done by the Kaiser Family Foundation puts Idaho’s Medicaid qualifying disabled population at only 49,800, it is a small price to pay to ensure the most vulnerable citizens are taken care of medically (Rudowitz 2014). When the ACA passed the plan was to simply expand Medicaid to everyone who fit certain parameters like those who lived 137% below the poverty line, but also forced private insurance companies to expand benefits to consumers, such as women’s wellness checks, diabetes screening and they could no longer deny insurance or financially penalize people for preexisting conditions (Ballotpedia, 2018).
For those who would still not qualify for Medicaid, but were still considered low-income, it provided tax credits to help pay for quality insurance through the ACA that had lower premiums and deductibles than the major privet insurance companies (Galewitz, 2010). It also put a more watchful eye on Medicaid reimbursement so doctors and hospitals were not over charging, frivolously spending on supplies and was providing adequate care to patients (Galewitz, 2010). However, in 2012 due to political partisanship, a change in the leadership in the House of Representatives and a Supreme Court ruling, the ACA was all put stopped in it’s tracks before it even really got moving. In 2012 the U.S. Supreme Court ruled that states could opt out of the Medicaid expansion which left thousands of people in what is now referred to as a Medicaid gap (Young, 2018).
In other words, these are people who don’t qualify for Medicaid and can’t afford private insurance. Prop 2 is a ballot initiative that was started by 2 grassroots organization appropriately named Idahoan’s for Healthcare and Reclaim Idaho and they are working on closing the Medicaid gap. If one were to vote yes on Prop 2 it would mean that you would want to expand Medicaid eligibility to those who are under 65 years of age that are not eligible for any state insurance and who live 137% under the poverty line (Manny 2018). A no vote would essentially leave everything the way that it is under the current Idaho Medicaid laws. Approximately 60,000 people currently fall into this Medicare gap and since they are uninsured most of these citizens are forced to use ER’s for all medical and psychological issues, even minor nonemergent issues, which causes them and the state to suffer from insurmountable debt (Manny, 2018).
This debt is eventually written off by hospitals, and other medical institutions, which falls on the backs of everyone who pays taxes and the people with no insurance are saddled with crushing debt forever. Idaho should expand Medicaid to its citizens because it will help a large portion of the uninsured population get insured which will help combat serious problems in the future that is linked to the uninsured. The 2017 census bureau reported that approximately 13% of the state of Idaho is currently uninsured; this includes adults and children but does not include those who are grossly under insured (Russell, 2018).
Several studies have come to the conclusion that those who are uninsured are less likely than those with insurance to obtain preventive care and services for chronic health conditions, both mentally and physically (Koh and Sebelius, pg. 1297-1298). Even if the uninsured are able to see a doctor they most likely will be unable to follow up with the recommended treatment, especially if they are sent to a specialist or it requires a special medication, because the treatments and medications are too expensive. Since the uninsured are not able to follow up with prescribed treatments or medication, they are more likely to be hospitalized in the near future or keep returning to an ER to help alleviate symptoms. For most these are avoidable health problems that could have been avoided if they had guaranteed treatment, but since their initial condition had gone untreated they usually will have incurred more medical issues, thus costing the hospital even more money to treat them. Hospital stays and ER visits are incredibly expensive and this puts people in extreme medical debt.
Currently medical debts contribute to about 52% of debt collection in the United Stated and in 2016 about 30% of uninsured adults said they were paying off least one medical bill (Vestal, 2018). In a nation as wealthy as the United States medical debt should not be financially crippling to people who have worked their whole lives this is why everyone deserves healthcare. A more controversial issue is why recently released inmates also deserve Medicaid just as much as any other citizen of Idaho and it’s because inmates are amongst some of the most vulnerable citizens. They are often over looked and dehumanized based on the fact they have been incarcerated but with 490 out of every 100,000 Idaho citizen in prison it is not an issue that can be overlooked (Vestal, 2018). When most inmates are released they are currently on some form of medication and because many of them come out with no familial support, no job prospects, and no insurance, many have to abruptly stop taking their medications, a problem that not only affects them, but the whole community.
This may be why Idaho has the 13th highest incursion rate in the nation, because the state is not helping prevent them from going back by simply aiding them with their medication and other medical needs (Bandara, 2015). Again, this is not just a problem for Idaho, according to Cal Berkeley PhD candidate Sachini Bandara, “The most recent national data available revealed that 24 percent of state prisoners reported substance dependence, 15 percent reported a mental health condition, and 42 percent reported both mental health and substance use disorders” (Bandara, 2015). This nation wide epidemic of incarcerated people is a serious issue that contributes to the rising costs of healthcare, insurance premiums, paying for parolees that go back to jail just because lack of access to medication, so in the end we all end up paying for their coverage.
Idaho citizens are already paying into a state run fund that helps those who are uninsured, a program in Idaho called Catastrophic Health Care Fund. It is a state run program that was started to meet the needs of the medically destitute who do not qualify for state or federal health care or other welfare programs (Russell, 2018). In 2016 it was estimated the program cost the state $33.9 million and Idaho counties paid for this by using property taxes from those who were unable to pay their medical bills. Since the counties are only responsible for the first $11,000 in a 12 month period, then the state becomes responsible for the remaining balance (Russell, 2018). After the ACA was passed caseloads for Catastrophic Health Care Fund fell consecutively from 2014 to 2017.
Then with the repeal of the individual mandate almost 4,000 people were dropped from their insurance because they no longer qualified for Medicaid and the ACA now had rising insurance premiums that they could no longer afford (Russell, 2018). There is an estimated 5,000 more will drop their insurance by next year since premiums are just getting higher and quality of care is becoming worse (Russell, 2018). If the Medicaid expansion were to pass the state would no longer need this fund. It would be more financially responsible to expand Medicaid so we did not have to pull resources from other places, like property taxes and state funds, to cover the uninsured. Not all citizens of Idaho believe the expansion of Medicaid will benefit the state, in fact they feel that this expansion will only promote citizens to become dependent on the government.
One Idaho resident, retired surgeon Dr. John Livingston believes “Medicaid expansion will allow many people to believe that when government steps in, they are discharged of their personal obligation to take care of their own family, friends, and neighbors”(Ballotpidia,2018). Although I do agree with Dr. Livingston that too much government interference is not the answer, there is no evidence that expanding Medicaid will cause citizens to neglect their personal or familial obligations. To the contrary two recent studies preformed in Illinois and Maryland, states that did decide to expand Medicaid under the ACA, found declines in uninsured ED visits and increases in Medicaid-covered ED visits (Cohen, 2017).
There is also the fact the Idaho citizens have worked incredibly hard to get Prop 2 on the ballot especially Luke Maryville, founder of Reclaim Idaho, and his team of private citizens worked tirelessly to obtain the 60,000 signatures required to get Prop 2 on the ballot. They began by organizing door-to-door campaigns in Sandpoint, Idaho and eventually was able to reach citizens across the whole state. They explained to voters that Prop 2 would save taxpayers money by keeping people out of the jails, and to keep people out of the emergency room (Manny, 2018). So far most peer reviewed evidence shows by expanding coverage to low-income people with physical and/or mental health issues, they’re more likely to contribute to society, less likely to end up back in the system or end up on public assistance. There are also many Idaho elected officials that vehemently oppose the Medicaid expansion claiming it will all but bankrupt the state if passed.
One such legislator is Lieutenant Governor Janice McGeachin who said at the 2017 GOP Convention “The current Medicaid program is already cannibalizing dollars for schools and roads by growing at a faster rate than other major programs and expansion will further erode support for other critical spending needs” (Ballotpedia, 2018). She went on to suggest that it should be the responsibility of “private nonprofits to provide healthcare to those in the coverage gap”, a suggestion that was puzzling at best (Ballotpedia, 2018). Again, there is no proof that the expansion of Medicaid would in anyway take funds from schools, roads or any other “critical spending” areas, a stance that Governor Butch Otter and House of Representatives chair Christy Perry, both Republicans, agree with praising the plan for Medicaid expansion (Davlin, 2018)
In fact, the United States is one of the only countries left in the world that does not offer universal heath care and other countries like Canada, China even Russia that do offer their citizens healthcare and have not abandoned this practice because there is no evidence to support it has bankrupted them. One of the reason why so many are against this is expansion is not because of how much money it will cost, but because of how much money some will lose. There is a small population of people making a lot of money from the current health care system in the US making up an astonishing17.4% of American GDP doubling what Australia or Japan spends (Hertel-Fernandez, 2016).
Even a naysayer like McGeachin would have to agree with such little evidence to support the idea that this expansion would bankrupt Idaho and with wide support from citizens and the GOP gubernatorial office, Prop 2 should not only be passed but remain uncontested. Even though Proposition 2 won’t mean universal health care for every citizen it will give the chance for more Idahoans to get the much needed insurance they deserve.
Even with all the opposition there is no solid evidence that Proposition 2 would bankrupt the state or cause Idahoans to become dependent on the government. In fact there is overwhelming evidence the passing of Prop 2 would free up funds from state run entitlements because the would no long have to use citizen’s taxes to fund them. Although there were some flaws with the ACA, it is a step in the right direction for the United States and the passing of Proposition 2, Medicaid expansion, will only help support what should have always been in place.
