Health Care

Idaho Considers What Could Be the Worst Obamacare Plan Yet

(Bryan Sikora/Dreamstime)

After rightly rejecting Obamacare’s Medicaid expansion for several years, Idaho officials have now concocted a new version of Obamacare expansion. While some supporters have rallied around the plan’s uniqueness, it’s important to examine exactly what distinguishes this expansion plan from the rest: It’s worse.

First, the truly needy already qualify for Medicaid in Idaho. Supporters of Idaho’s Obamacare plan want the public to believe that this plan is essential to the survival of Idaho’s neediest residents. But the truly needy already qualify for Medicaid in the Gem State.

Idaho’s Medicaid program already covers low-income kids, pregnant women, seniors, individuals with disabilities, women with certain types of cancer, individuals who require home-based and community-based care, individuals in mental hospitals, low-income parents, infants of Medicaid-eligible pregnant women, and more.

Idaho’s new Obamacare plan doesn’t help the most vulnerable — it threatens them by diverting tax dollars to able-bodied adults and further straining the safety net.

Second, Idaho’s plan would implement a new part of Obamacare and expand it to more people. Idaho’s expansion plan would authorize the state to apply for a Section 1332 waiver, which earned its name because it was created by Section 1332 of Obamacare. The state hopes to use this Obamacare waiver to expand Obamacare subsidies to able-bodied adults below the poverty line. State officials previously predicted that “only” 78,500 able-bodied adults in this income range would sign up for an Obamacare expansion (although there is plenty of reason to believe actual enrollment will be higher).

Third, Idaho’s plan would create the highest Medicaid eligibility for able-bodied adults in the nation. While advocates of this Obamacare plan may pretend that it does not expand Medicaid, it would create a new Medicaid eligibility category for individuals who earn up to four times the federal poverty level, moving high-cost enrollees out of the Obamacare exchange and into Medicaid.

If approved, this would give Idaho the highest Medicaid eligibility in the country — more than double the eligibility levels of liberal states such as New York and California and of neighboring states such as Washington and Oregon. This new eligibility limit for able-bodied adults would also be more than twice as high as Idaho’s income limits on Medicaid for kids and pregnant women.

Idaho’s massive eligibility expansion would allow single adults without kids who earn up to roughly $49,000 per year to qualify for Medicaid. For a married couple without kids, eligibility would extend up to $66,663. To put that in perspective, the median income in Idaho is $49,174.

And finally, no one knows how much it would cost. The state estimates that roughly 1,500 individuals would move from the Obamacare exchange to Medicaid. For the additional group, based on earlier estimates from the state, at least 78,581 could sign up.

State officials claim that costs for the 1,500 individuals moved to Medicaid will be roughly $100 million and that the additional group will cost the state nothing. (They’re hoping to redirect federally financed subsidies from those they’re moving out of the exchange to this group instead, a move they claim would be cost-neutral.)

But the reality is that no one knows. HB 464 contains no limit on enrollment, and Obamacare-expansion states have consistently and greatly exceeded their promised enrollment targets.

HB 464 contains no limit on enrollment, and Obamacare expansion states have consistently and greatly exceeded their promised enrollment targets.

In fact, Obamacare-expansion states have signed up more than twice as many adults as they said they would.

A recent report from the Foundation for Government Accountability also found that expansion states are spending 157 percent more on expansion than projected.

If Idaho lawmakers want more information about these cost and enrollment overruns, they should ask their neighbors.

In Montana, Obamacare expansion is 70 percent over budget, with more than 86,000 able-bodied adults enrolled. Just 45,700 were ever supposed to sign up.

In Washington, expansion is $2.8 billion over budget; enrollment has exceeded projections by more than 330,000 able-bodied adults.

Nevada said they would sign up only 78,000. To date, they have enrolled more than 220,500.

And in Oregon, expansion is nearly $3 billion over budget, costing taxpayers nearly twice as much as promised so far, with nearly 200,000 more able-bodied adults signed up than projected.

While supporters of Idaho’s Obamacare plan might like to dismiss these concerns because their plan is “different,” the harsh reality is that their plan expands Medicaid and Obamacare subsidies to much of the same population as Obamacare, giving them Obamacare benefits with Obamacare dollars, and with no enrollment cap.

Even if Idaho’s Obamacare plan somehow makes it through the legislature, there’s virtually no chance it would ever be approved by the Trump administration. But if it were, it would give Idaho the highest Medicaid eligibility in the country and become the worst Obamacare expansion to date.

Nicholas Horton — Nicholas Horton is the research director for the Foundation for Government Accountability.

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