There is a bright side to the Medicaid sideboards

A good number of people — especially on the Democratic side — have good reason to be seething over the passage and governor’s signing of the controversial “sideboards” law that goes with Medicaid expansion. But there is a bright side to an otherwise sorry story.

Thousands of working Idahoans who fall into the coverage gap — those who make too much income to qualify for Medicaid and too little to be covered under the state exchange — finally will get access to health insurance. Sure, there are enough bureaucratic strings attached for a Broadway puppet show, but the flawed plan that came out of the Legislature is a vast improvement on six years of inaction by the lawmakers.

Granted, 61 percent of the voters were not thinking about massive “sideboards” when they approved Prop 2 last November. It’s not what Democrats, or even a fair number of Republicans, wanted. Some number-crunchers say that Medicaid expansion, with those “sideboards” could cost as much as $40 million. Medicaid expansion without restrictions would be only a small fraction of that amount.

Gov. Brad Little is taking heat for signing the bill, and justifiably so. Suffice it to say that the political honeymoon that he has enjoyed through the first few months in office is over. Critics will say, again justifiably so, that the governor failed to show leadership, or the courage to stand up to the Republican majority.

Or, maybe he just wanted the session to end before August.

Confusion over his actions is understandable. Little, the self-described policy wonk, normally is not one who would put his name behind a bill in which the fiscal impact is as clear as mud. He expressed concerns about the cost and the administrative burden placed on Medicaid recipients and suggested that the Legislature take a closer look at those items. We’ll see if lawmakers follow his advice. Of course, the Legislature could have even more problems to deal with if it ends up being on the losing side of a court ruling.

This issue puts a different twist on the definition of “liberals” vs. “conservatives.” In this case, the so-called “liberals” (Democrats) called for simply honoring the wishes of Idaho voters without the bureaucratic fanfare. “Conservatives” wanted Medicaid recipients to have accountability, which is in line with conservative thinking. But they are calling for creating a bigger government to enforce the sideboards, and the heck with the cost to taxpayers. Go figure.

But, again, let’s not dwell on the negative. Sen. Mary Souza, R-Coeur d’Alene, one of the Legislature’s clear-thinking conservatives and a major player in putting together the winning bill, offered a brighter view of the issue in her recent newsletter to constituents.

“This bill is designed to fulfill the will of the people voting for Medicaid expansion by providing health care to the working poor in Idaho,” she wrote. “It asks for federal waivers to allow people who currently have insurance on the (state) exchange, but will now qualify for Medicaid, choose which they would prefer.” She added that those who are not exempted from work, but are in the expansion, would be required to spend at least 20 hours a week working, participating in job training, or looking for work.

For the vast majority of folks taking advantage of Medicaid expansion, compliance with the sideboards should not be a big issue. These are honorable people who happen to be stuck in low-paying jobs. What came out of the Legislature, even with the imperfections, still is a better deal for the working poor than what the Legislature has provided over the last six years — which was nothing.

Despite what the critics are saying today, passage of Prop 2 was not a meaningless exercise. Idaho voters forced the Legislature to finally do something to help a lot of well-deserving people.

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Chuck Malloy, a longtime Idaho journalist, is a columnist with Idaho Politics Weekly. He may be reached at ctmalloy@outlook.com.