Medicaid: A cancer on state government

By Wayne Hoffman

 Sen. Brent Hill, whose colleagues elected pro tem earlier this month, opined in 2005 that Medicaid's spending is out of control. Wrote Hill, "When a small number of cells in an otherwise healthy body multiply without control, healthy tissue is destroyed and survival of the whole body is endangered. The condition is called cancer. When a small number of programs in an otherwise healthy government multiply without control, the condition is called Medicaid."

It's a great illustration. Hill caught on to this issue long before many of his peers. I vividly remember one year that the Department of Health and Welfare showed up at the Legislature asking for emergency spending authority of millions of dollars to prop up Medicaid for the remainder of the year. Such a request requires lawmakers on the joint budget committee to "re-open" the Medicaid budget. Normally, a request to do so is perfunctory. Hill objected, and the panel was unable to muster up the votes needed to throw cash at Medicaid. Hill eventually won some assurances from the department that it would find ways to control the Medicaid bleeding, and he allowed the budget process to move forward. Hill's objection wedged in my memory as one of the few times the Legislature really balked at the overflow spending in the state-federal healthcare partnership.

The state is, in fact, an unwitting accomplice in the Medicaid expansion. For years, lawmakers bought into the notion that adding layers to

Medicaid was the cheapest way to provide healthcare services.

The Access Card program, one expansion of Medicaid that costs more than $600,000 annually, is an example of legislators' attempt to cut healthcare costs at minimal expense to local and state taxpayers. Originally created some seven years ago, the Access Card program is supposed to help make insurance more affordable by helping Idahoans buy coverage.  Participants in the program can earn up to 185 percent of poverty and still get a subsidy of up to $100 a month to help buy insurance (with a maximum of $300 a month for children or $500 a month for a while family).

I'd question why anyone earning well in excess of poverty thresholds should be enrolled in a government entitlement. The inevitable result is bigger government that no longer provides safety-net services to the neediest, but entitlement benefits for everyone. To illustrate my point and defend Hill's cancer analogy, the federal government is throwing the doors wide open on the Access Card program, and through Obamacare, mandating its own insurance premium subsidy for people earning up to 400 percent of poverty. The federal government is now attempting to require the state to develop a plan to transition Idahoans off the Access Card program and onto Obamacare.

This is the definition of a malignancy. The state is already facing its own budget shortfalls. It must start finding ways to cut the Medicaid tumor that's overtaking the rest of the state budget, and to start that process in January 2011.

 Wayne Hoffman is executive director of the Idaho Freedom Foundation.