I have received many inquiries concerning the Medicaid Gap population and asking to expand Medicaid.  This is my take on basic issues.

  1. Medical costs have gone from 4 percent of the GDP in 1964 before Medicaid and Medicare began to 18 percent of the GDP today. Government spending has distorted the market place as it has taken over a larger share of the market.  In short, medical spending as a percent of the GDP is at least twice to 4x what it should be.
  2. Medicaid and other federal poverty programs create benefits cliffs that encourage recipients to stay poor in order to maintain eligibility. Federal poverty programs have not changed the percent of those in poverty.
  3. Medicaid and other federal poverty programs are funded by running continual deficits placing a debt on unborn generations. Our grandchildren are being required to pay for our current expenses.

I simply cannot expand failed federal programs.  So what is to be done?

It was suggested that Idaho try to reform the Medicaid program by creating a state-run, state-financed medical program for the Medicaid Gap that did three things:

  1. First, focus on primary care rather than hospitalization like Medicaid does.
  2. Build community supports and community networks using Community Health Centers
  3. Help the Medicaid gap population pass through poverty as quickly as possible so that they can help pull the wagon rather than make the wagon more comfortable to ride in.

So what happened?  The Idaho House struggled with these issues all session and eventually sent a bill to the Senate.  The House version provided $5 million to Community Health Centers and set up a mechanism to continue the discussion.  The Senate amended the bill asking Director Armstrong to begin the process of getting a waiver from the federal government to reform Medicaid.

Many conservative members of the House and the Idaho Freedom Foundation said this was a backdoor expansion of Medicaid and had it killed.  So what will happen?

The issue is still before us.  We will either expand the old Medicaid system or we will try to reform Medicaid.  I will continue to work to reform the Medicaid system by focusing on primary care, building community supports, and help the poor pass through poverty as quickly as possible.  It seems to me that if we are ever to reform federal poverty programs; we would have to do these three things. Why not start in Idaho next session?

Conservatives have to wrestle with that fact that the big-government poverty programs coming out of Washington D.C. will not be reformed by simply voting ‘no’ to every proposal that does not pass the purity test of traditional conservative thought. Will conservatives in Idaho engage and offer win-win solutions?  I hope so.