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Medicaid expansion is a huge state budget weight

Updated: Jul 21, 2023

When Idaho voters passed Medicaid expansion in 2018, a lot of promises were made. Few, however, have panned out.

There were promises of limited enrollment – 60,000. The latest numbers show more than double the projection and more than 1 in 4 Idahoans now enrolled.

There were promises it would be a good financial deal and lower health care costs. That hasn't happened either.

The 2023 Idaho legislature's budget increases the Medicaid state spending to $856.3 million - a 25% increase from just four years ago. If the trend holds, Idaho will hit one billion dollars in Medicaid spending in the next few years.

Proponents of the system claim it's a good deal because the federal government is covering so much of the actual cost. Just a few months ago, state legislators were told Idaho would have to spend more if it ended Medicaid expansion.

How is that possible? It's true that, comparatively speaking, federal taxpayers cover more than state taxpayers- so limiting or ending the expansion limits or ends the federal government's funding.

However, it's worth pointing out that state taxpayers are federal taxpayers too. And, judging by the federal government's current financial position, promises of federal funds might not always be there.

If a bankrupt relative bought you a vehicle you couldn't afford, but said he'd make most of the payments, would you sign up for the deal?

It’s not as if there were no other options. Before Medicaid expansion in Idaho, those who were eligible could join the Your Health Idaho program and get “advance premium tax credits” to help reduce their insurance costs.

Medicaid coverage, on the other hand, can be extremely limiting. Not only do providers run into billing problems, but reimbursement rates are also low. Many health care providers will only take a limited number of patients. So, while citizens may have coverage, it might not mean much.

Medicaid, Medicare and Private insurance acceptance rates:

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