Will Idaho expand Medicaid in November election?

Low-income Idahoans will finally have health insurance if the new Medicaid expansion initiative is approved by voters in November. Reclaim Idaho collected 56,192 signatures, enough to get the measure on the ballot. With passage of the initiative, an estimated 62,000 uninsured adults in the state would become eligible for Medicaid. The initiative would override the state legislature’s 2016 decision not to adopt the Medicaid expansion under the Affordable Care Act.

Initially, the Affordable Care Act allowed the federal government to withhold funds from states that didn’t expand Medicaid.  However, in 2012, in NFIB vs. Sebelius, the Supreme Court struck down this provision and the Medicaid expansion became optional for states.

Without the Medicaid expansion, eligibility for Medicaid in Idaho is limited to children under 5 up to 142 percent of the poverty level and 6-18 at 133 percent; pregnant women up to 133 percent; adults receiving SSI disability benefits and some parents and caregivers up to 23 percent of the poverty level. The method for calculating adjusted gross income can, in effect, raise these limits to 138 percent and 26 percent of the poverty level, respectively. For example, with an annual income of $12,140 as the poverty level for an individual and $20,780 for a family of three, 138 percent of the poverty level corresponds to $16,753 and $28,676, respectively. 26 percent corresponds to $2,792 per year for an individual and $5,402 for a family of three. Adults with no children are not eligible for Medicaid at all in Idaho. 

Childless adults below 100 percent of the poverty level have no health insurance options available because they are also ineligible for subsidies in the health insurance exchange.

Because the ACA was passed with an enforced Medicaid expansion, no provision was made for persons below 100 percent of the poverty level to enroll via the exchange. The Supreme Court decision rendering the Medicaid expansion optional resulted in a coverage gap in which childless adults below 100 percent of the poverty level are ineligible.

The text of Proposition 2 is simple and concise. It expands Medicaid eligibility to all persons below the age of 65 whose adjusted gross income is 133 percent of the poverty level and below. It specifically mandates the state to implement the changes. No text on the subject of work requirements is contained in the ballot measure.

Who would gain health insurance under the Medicaid expansion? Here are some hypothetical examples:

Holly works full time, nine months of the year, at a private day care facility. She earns minimum wage and has no health insurance benefits. Her annual salary is below the federal poverty level. 

George’s job was eliminated when he was 57 years old. He then had cancer and was unable to work. His countable assets were depleted because of medical bills and monthly expenses without a job. He was not eligible for permanent SSI disability. He is not yet eligible for Medicare or Social Security.

Hospitals in the state would have a better chance of remaining solvent with the expansion of Medicaid. Reclaim Idaho, the group that collected signatures for the initiative, reports that of the more than 80 rural hospitals nationwide that have gone out of business, 90% were in states that didn’t expand Medicaid.

To campaign for passage of the initiative, Reclaim Idaho partnered with the Idaho Medical Association and other groups to form Idahoans for Healthcare. Volunteers are traveling throughout the state in a green bus to distribute information.  The campaign recently completed an intensive 20 days of action.

Some Republican elected officials have joined the campaign to pass the initiative. However, Ballotpedia reported that the state’s Republican convention adopted a resolution in opposition, authored by its nominee for Lieutenant Governor, Janice McGeachin. The resolution employs the death metaphors characteristic of arguments opposing health care measures, alleging that “the current Medicaid program is already cannibalizing dollars for schools and roads by growing faster than other major programs.”

What chance does the initiative have of passing in a traditionally red state? Voters in Maine approved such an initiative in 2017. Anna Maria Barry-Jester of FiveThirtyEight cites several Idaho survey results overwhelmingly supporting extending health care to low income populations and one opposing the Republican legislature’s rejection of the Medicaid expansion.  However, she believes that the vote could be susceptible to smear campaigns claiming that able bodied adults and former inmates would become eligible.

The initiative will have credibility because of endorsements from a broad array of twenty-nine professional organizations, including Boise Metro Chamber, Idaho Academy of Family Physicians, Idaho College of Emergency Physicians, Idaho Association of Commerce and Industry and United Way of Treasure Valley. 

The ballot initiative will be a test of the effect of the recent influx of Californians to the state. The new voters include homeowners fleeing the forest fires, progressives seeking affordable housing and a greener lifestyle, conservatives who felt out of place in California’s liberal culture and newly hired tech workers.

A gubernatorial election on the ballot will also influence this year’s voter turnout.