Medicaid expansion and your Legislature

The backslapping and hand shaking for a job well done is over.

After months of door knocking despite cold or hot weather, the Medicaid expansion initiative was passed. Now it’s time for the Legislature to act.

This should be an easy task since the Reclaim Idaho group and the voters did all the heavy lifting. The Idaho Legislature convenes next week, should look at the election results and rubber stamp the will of the people. It’s more likely they’ll pursue a path like other states with Republican control and seek “flexibility” (the term often used) and choose to redefine the will of the people. Somehow our elected leaders always feel a need to improve, clarify or protect us, the voters.

Seventeen states with Republican-controlled legislatures have failed to pass Medicaid expansion as allowed under the Affordable Care Act. A Kaiser poll conducted across all 17 states indicated that 56 percent of the voters favored expanding Medicaid. In fact, Medicaid remains a popular government service throughout the country. The question is, will Idaho do what some other states have done to ensure this so-called “flexibility”?

Some Republican lawmakers have opposed Medicaid expansion, claiming high costs to the state budgets. Currently on average, Medicaid pays 62 percent for the traditional population, leaving 38 percent to be paid by the state.

The federal government under the expansion pays 90 percent for the newly eligible adult population. Upon the signing of the election certification of Medicaid expansion on Nov. 20, Lt. Governor and Governor-Elect Brad Little stated money should not be a problem. According to the Idaho Press, Little stated, “It’s not a big dollar issue relative to a lot of other decision units the Legislature addresses.”

I take the governor-elect at his word. What have other “red” states done upon implementing Medicaid expansion?

A few states are considering or have applied for federal government waivers that allow them to implement work requirements, time limits, co-pays and/or drug tests.

Arkansas may be a prime example of what not to do in the name of providing “flexibility.” Arkansas established a work and reporting requirement for people who qualified for Medicaid under its expansion. Unless exempt, enrollees must engage in 80 hours of work or other qualifying activities each month and must report their work, using the state online portal, by the 5th of the month.

A total of nearly 17,000 people have been disenrolled for non-compliance with the work and reporting requirements since September. This could mean that they did not create and link the online accounts required to enable them to report or had some difficulty accessing or navigating the online portal. This high level of disqualification should be a warning sign that the current process might not be structured to provide working poor individuals an opportunity to succeed.

An early review found many enrollees had not been contacted about the requirement. People eligible for Medicaid coverage could be left out for months. Keep in mind Medicaid is primarily for the working poor, people who may have cellphones but often lose access due to costs and further have limited at-home internet access, which requires a monthly fee.

Kentucky also imposed an 80 hours per month requirement. Kentucky went a step further and required monthly premiums of up to 4 percent of monthly income. There is a six-month lockout of coverage provision for failing to comply.

The working poor, a single mom with children or a man struggling to feed his family, have little if any extra money after rent, food and gas for the car to get to work. If Medicaid does not require it, is it fair to charge another fee to people who cannot afford to pay? These actions touted as maximizing states’ flexibility, have one major outcome: coverage for fewer people.

“The net effect of work requirements, premiums, and lockout periods will be fewer enrollees, and more people will be kicked off for failure to work or pay premiums,” said a review in The Atlantic.

Conservative legislators seeking to get out in front of public opinion which is going against their current position are using these mechanisms to short circuit the intent to give coverage to more people and are in effect reducing Medicaid participation. These efforts at “flexibility” require more bureaucracy to oversee. Couldn’t this money be put to a better use?

I believe the Idaho Legislature is listening to the people’s will on Medicaid expansion but I’m not certain they hear us. The initiative as passed did not include a proviso that the working poor must somehow qualify to receive health care. The initiative was quite straightforward in its wording.

People may have less due to lack of education, poor decisions, lack of decent paying jobs, loss of a job, etc. If a person doesn’t have a job, then using that as a reason to deny them Medicaid coverage is simply not right; it’s not even reasonable. Sick people often cannot work but healthy people have a chance to climb the economic ladder. Perhaps Medicaid has popular support across America because we as a people tend to favor the underdog and want to help those who have less.

In politics there is what is called the third rail, often a reference to Social Security. Any politician knows that to touch it is like touching the third rail in the subway, which is the high voltage line. Touch it and be prepared to end your political life.

Maybe Medicaid should be the new third rail. We voted for it, we support it and will hold our elected leaders accountable if they touch it. Health care is more than a convenience or luxury for those who can afford it. Providing it for those who have less is what we believe.

This rigidity in the name of flexibility is simply mean and like giving people a ladder to climb which has no rungs. If you currently hold public office here in Idaho, I might suggest you not just listen to the will of the people but also hear us because we are watching. Touch the third rail at your own risk.

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Phil Ward is a Coeur d’Alene resident.