After the last legislative session, a special task force was convened to explore how to save money in the Idaho Medicaid program. There are only three ways to save money in the Medicaid program: reduce the number of people on Medicaid, provide people with fewer services, and reduce payments to providers. After the 2024 session Senate Bill 1456 appropriated $4.7Billion to Idaho Medicaid. This was the largest line item in the history of any Idaho budget. Today in Idaho the promise of “you can keep your doctor; you can keep your plan” has been proven to be false. Improving “access, quality, and costs” has also proven to be vacuous.
As with almost every good or service subsidized or incentivized by government, the costs of those goods and services goes up. Almost always. Health Care premiums in the commercial individual and group markets have continued to grow just as they did pre-ACA. WE THE PEOPLE are paying for these programs with both our insurance premiums (“cost shifting”) and taxes. I guess if you are a legislator that receives health insurance from the State with your part time job it doesn’t make much difference! As demand goes up and the supply curve is shifted up and to the right, and as the number of providers (supply) goes down as it has in Idaho on a per capita basis, costs go up.
The economic experts like Rham and his brother Eziekiel Emmanuel told us otherwise when they were peddling the Affordable Care Act (ACA)—aka “Obama Care” like snake oil salesman. They were wrong and we predicted that they would be wrong in 2018. I have never considered myself an expert in anything outside my profession of medicine and surgery. Maybe more doctors and nurses should have been consulted about the (ACA) claims prior to their being initiated. The same thing could be said about the “experts” both in government and in our for profit and non-profit institutions in and outside of Idaho, who guided us through the faux Covid pandemic.
Medicaid spending has doubled in Idaho in just the last 6 years! Large hospital systems and insurance carriers apparently are doing very well as their executives continue to make seven figure salaries, while labor costs have remained flat. The reason we in Idaho continue to enjoy great health care is because we have outstanding doctors and nurses and technicians who share in today’s world a unique work ethic with the patients they serve. Ever growing bureaucracies inside and outside of government have nothing to do with “quality and access”, but they have everything to do with cost. Hospital and insurance company executives making seven figure salaries have nothing to do with the health care that is delivered at the bedside, in our emergency rooms, or our clinics—just ask the doctors, nurses, and technicians who work for patients in those areas, about the support the receive from “on high”.
Fred Birnbaum in an article posted by The Idaho Freedom Foundation last year identified an “iron triangle of interests” that continues to drive health care cost higher and higher. “Who are these interests? The federal bureaucracy—specifically, the Centers for Medicare and Medicaid (CMS), the State Medicaid Division, and the providers of Medicaid services themselves, including hospitals and the pharmaceutical industry. Historically, over 95% of the budget is paid to Medicaid providers”, meaning they receive about $4.5 billion of the budget—65% is paid by the Federal government, but 35% of $4.5 billion is a lot of money that becomes annually a heavier burden to the people of Idaho—$1.6billion. If the Federal Medical Assistance Program (FMAP) changes by even 5% for either traditional Medicaid or for individuals covered by Medicaid Expansion, balancing a state budget will be increasingly problematic risking our States Reserves of almost $1.6billion. I truly believe that one of the reasons that the grocery tax is being placed on hold is that those in government fear a “draw” on reserve accounts that would impact our bond rating.
And look who is lobbying for an ever-increasing Medicaid budget and against repeal of Medicaid expansion. The IMA and the IHA. Their appeals are mostly grounded in emotion and anecdote. They wrongly assume a compassion that they believe is not shared by those asking for reform. Years ago, a lobbyist for a large health care organization made such a claim during a radio interview. And I must paraphrase from memory what he said: “We care more for those on the margins who through no fault of their own cannot take care of themselves, than those arguing for reform do”. Here is the truth: Medicaid was designed to help those most in need. By expanding and paying for insurance products for the young and healthy who are living on the margins, it only jeopardizes the accessibility of health care for the most vulnerable. When cuts are made later instead of today, those patients will be impacted the most! Just like in 2018, the “experts” are once again wrong.
The price to be paid for Medicaid reform today will be much less than if we just “kick the can down the road. Those paying that price will be the very patients Medicaid was designed to fix.
