I have been vocal about my opposition to Medicaid expansion. First, I would like to share five simple reasons why I have come to this conclusion and, second, what I do support and why.
Medicaid has the wrong focus. It pays for expensive hospital care while largely ignoring the importance of primary care. A low-cost, quality national medical system must first focus on providing quality primary care to its citizens using either market forces or state-supplied. (I prefer market forces.)
Medicaid is funded through increasing the national debt which will be paid by future generations either in lost earnings or personal suffering when the economy collapses. It is our responsibility to fund our own medical expenses out of this generation’s earnings. To use a debt instrument to fund our current expenses is inter generational theft and immoral.
Medicaid is government by regulations that emanate from Washington D.C. The practical application of this reality is that the federal government is regulating the interaction between Idaho medical providers and Idaho medical recipients. The federal government was never designed to directly touch and control the lives of Idahoans. Medicaid violates the principles of federalism which state that the federal government should be responsible for a few activities while the states should be responsible for other, more expansive, activities.
Medicaid underpays providers. Many providers can no longer take Medicaid patients because they lose money when they do.
Medicaid is based upon the Consumption Theory of Prosperity which uses wealth transfers rather than helping people get out of poverty through production.
I simply cannot expand a program based upon such a flawed foundation. However, there is another option. It is called PCAP or primary care access program.
PCAP is being debated in the Idaho legislature this year and is based upon the following principles:
- Focus on primary care; funds would be given to Community Health Centers to expand their efforts in helping poor Idahoans receive basic medical care.
- The program is funded with state funds out of our current income stream. No debt required.
- Because state funds are being used; state rules govern the program. This means Idahoans will interact with other Idahoans using Idaho rules.
- These state rules could be based upon the Production Theory of Prosperity which would help the poor achieve a state of higher productivity so that they can create a self-sustainable standard of living.
- PCAP would put us in a good bargaining position to seek a Medicaid waiver to help with hospital costs until we put in place other sound policies which will reduce the cost of medical care. Eventually, the goal is to wean ourselves totally from federal money.
The legislature is working hard to solve some of the problems associated with poverty and the lack of access to medical care without taking federal money to do so. While Medicaid expansion may seem like a good idea, the reality is that by 2025 the cost will be $107 million per year to the state if Idaho expands Medicaid. The cost of PCAP would be closer to $30 million per year.
PCAP changes the discussion and puts us on a different glide path where state rules are used and medical cost reduction may be achieved. Expanding Medicaid does nothing but solidify and enshrine an old, tired, inefficient federal program.