The Challenge of Dealing with Referendums like Medicaid Expansion


Last November, Idaho voters approved the proposition to expand Medicaid, but the process of getting the program funded and done right, if at all, is not so clear. The proposition passed by voters didn’t speak to how it was to be funded, nor did it address other details such as work requirements and limitations. This is where the legislature comes in.

A recent editorial by Susan Ripley, president of the League of Women Voters (LWV) states: “The League of Women Voters of Idaho formally voices opposition to any bill that includes cuts and other modifications to the Medicaid expansion proposition as passed by 61 percent of the voters in November’s election.”

Because the voter-approved proposition never mentioned funding, any expansion bill in the legislature must address Idaho’s costs and potential spending caps (not cuts). The bill could also include restrictions and limitations like work requirements for recipients. It’s even possible for the legislature to reverse course and override the proposition altogether.

History offers some perspective. Idaho’s law allows almost any idea with enough signatures to be placed on the ballot. In the 1990’s Idaho voters approved term limits for state and local officers. However, in 2002 the legislature ignored “the will of the people” by voting to repeal term limits, and even overrode Gov. Kempthorne’s veto.

“We are all pleased that we have had the courage . . . to take this action — which is in the long-term interest of the state of Idaho,” Republican House Speaker Bruce Newcomb said after the vote. He said term limits were ‘sold to the people of Idaho’ by special interests outside the state.” In the end, the legislature chose what they believed to be best for Idahoans.

Similar to term limits in the 1990s, this year’s Medicaid expansion was also “sold to the people of Idaho” by outside special interest groups. Reclaim Idaho spent millions of dollars—from outside the state—and spread oodles of misinformation and lies about Medicaid to get Idaho voters on board. Frankly, Idaho voters were misled. Medicaid expansion is a bad policy and our legislators should oppose this latest attempt at more socialism, in the form of government interference in healthcare.

The LWV article also included this question: “Why risk millions in Idaho taxpayer dollars when other states have already shown the folly of [expanding Medicaid with limitations]?” They are referring to Medicaid expansion with limitations and work requirements as was used in Arkansas and Kentucky. This question more broadly begs us to learn from states that have dramatically increased Medicaid benefits, and are now scrambling to figure out how to pay for massive cost overruns.

Despite supporters’ claims, there is no economic stimulus with the implementation of Medicaid expansion, and those who are most needy may be pushed further toward the back of the line (those with disabilities, the elderly, children, and those with limited income). The LWV laments “this bill will just grow more government with bureaucracy and red tape.” They are not wrong; but that is the story of Medicaid, period.

According to a Foundation for Government Accountability report in 2018, states that have implemented Medicaid expansion have experienced explosive growth in the number of enrollees, as well as the associated cost.

The voters may have supported the Medicaid expansion proposition, but I believe our citizens were really asking our state leaders to address increasing healthcare/insurance costs for all of us. We can create an Idaho solution that does not break our budget. It’s called free healthcare markets, not more bloated and mismanaged government.