Medicaid expansion: One issue is how much trust to place in federal promises

Hendricks Farm Bureau
[post_thumbnail] Russ Hendricks, director of government affairs for Farm Bureau of Idaho, says Medicaid expansion promises to alleviate the costs of the indigent program for county government, but that trusting the federal government is another issue.

As an end-of-the-year deadline nears for the Obama administration’s Medicaid expansion offer to the states, groups and individuals across Idaho are weighing in with their official positions on the idea.

“The expansion of the Medicaid program is certainly not inevitable,” said Steve Ackerman, an independent industry analyst and adjunct professor at College of Idaho in Caldwell. “In fact, there are plenty of good reasons to not do this,” he told

Begun in 1965, the Medicaid program provides certain health care services to individuals and families with low incomes and limited resources. Financed with a combination of federal and state tax revenues, the expanding costs of Medicaid have in recent years become a topic of growing concern among the individual states, despite the eligibility of the program being based on a variety of means testing processes.

A key element of President Barack Obama’s Affordable Care Act (Obamacare) law was to have mandated that the individual states reduce eligibility requirements for Medicaid and expand the number of participants in their respective programs. However, the United States Supreme Court overturned that component of the Obamacare law, so expansion of Medicaid is now left as an elective choice for each individual state.

After that Supreme Court ruling last year, the Obama administration presented the individual state governments with a revised proposal: Expand Medicaid eligibility during the calendar year 2013 and the federal government will pay the costs of the expansion for the first three years.

In January of this year, Gov. Butch Otter Otter noted in his State of the State address his belief that Idaho’s Medicaid program is “broken,” but also stated that he did not intend to seek expansion of the program during this calendar year. Despite his expressed intentions, a legislative effort to expand Medicaid was undertaken in the Idaho House in March by Rep. Tom Loertscher, R-Iona.

While Loertscher’s legislation failed to get traction, the task force that Otter assembled to study the issue of Medicaid expansion unanimously recommended in March that Otter take the federal government’s offer and that, in its view, the state could save anywhere from $44 million to $100 million for each of the first three years of the Medicaid expansion.

But the notion that the Idaho state government would “save” money as Idahoans become more dependent on a federal entitlement program is a questionable assumption for Ackerman, who believes that the “offer” of the federal government is not necessarily a good one.

“Today the federal government funds about 74 percent of Medicaid in Idaho and if we take the expansion offer, that percentage will expand,” Ackerman said. “But the population of Idaho is expected to grow over the next 10 years. Combine this with the fact that the federal government is proposing to expand consumption of Medicaid and it begs the question, can the federal government really afford to promise all these things to us?”

Ackerman is not the only Idahoan who is skeptical of the promises of the Medicaid expansion plan.

“Medicaid promises to relieve the county governments of the cost of indigent care,” said Russ Hendricks, director of government affairs for the Idaho Farm Bureau. “But that’s assuming that we can take those in our federal government at their word. Our members are concerned that Medicaid expansion will not be good for the citizens of Idaho, and their biggest concern is that they really don’t trust the promises of their federal government.”

He continued: “As we see the rollout of Obamacare, we observe that many components of it are happening in exactly the opposite way that they were promised. For example, Obamacare was supposed to reduce health insurance costs for families and households, yet prices are rising dramatically even as Obamacare is phased in. We don’t trust our federal government on this, and we oppose the Medicaid expansion idea.”

Of Medicaid expansion, Ackerman noted that there are no guarantees as to what percentage of the program’s costs will be paid by the federal government after the initial three-year period of expansion.

“Idaho is poised for population growth,” he told “Some health care analytics are projecting that our population may expand by as much as 50 percent. If the federal government even wanted to pay for all these additional Medicaid recipients in our state, the only way the government could contain the cost of it would be to scale back the health care services that are provided.”

He noted that in 2009, the U.S. Preventative Services Task Force, a medical experts’ panel that advises the U.S. federal government on Obamacare implementation, published a recommendation that women should postpone mammograms until the age of 50, a complete contradiction to private organizations like the Susan G. Komen Breast Cancer Foundation that advises women to begin receiving the exams in their mid-30s. “That was an effort toward health care rationing,” Ackerman explained, “and we’ll see more efforts at rationing as more people become dependent on Medicaid.”

If Medicaid is to expand in Idaho, such expansion would need to be authorized by the Legislature. When asked in May if the governor intends to call the Legislature in to special session to authorize an expansion of the program before the Obama administration’s year-end deadline, Otter spokesperson Jon Hanian would only say that “the governor will continue to include the Legislature in the process.”

A complete discussion with Ackerman can be heard HERE.

Note: Steve Ackerman is a member of the board of scholars for the Idaho Freedom Foundation. is published by the Idaho Freedom Foundation.




  1. Tim Hohs

    If we are worried that the federal government might renege on the 100% payment during the first 3 years, or the 90% after that, we can drop out when they do. We’re talking about health care here. This is not something that freeloaders will go out and party with. I know many Idahoans who simply cannot afford health care now. My sister-in-law was suspended from her job because she needed a hernia operation. Through the federal PCIP plan (now defunded and suspended) she got insurance for her operation and went back to work, instead of collecting welfare for her and her child.

    Denying health care to poor Idahoans by not allowing Medicaid expansion is not only shamefully miserly but wastes human resources, hurts our local governments, and is giving up a lot of money that our economy could desperately use.

  2. Tom Shanahan, Public Information for Idaho Medicaid

    Austin—Your article about Medicaid expansion has a few points that your readers may appreciate clarification on as they evaluate the issue:
    1. The original Affordable Care Act states the federal government will pay 100 percent of claims for the expansion population the first three years. The federal government did not offer a “revised proposal” to entice states to expand Medicaid; the 100 percent federal payment was there from the beginning.
    2. There are, in fact, guarantees for the federal payment percentage after the initial three year period. The law actually specifies the federal payment percentage for each year through 2020. The federal payment percentages reduce from 100 percent in the first three years to 90 percent by 2020. Congress would have to change the law for the federal percentages to change.

    Thanks for the opportunity to address these two issues.

  3. chris

    The arguments NOT to expand Medicaid are so strange sounding Has anyone asked the people who will be covered (or not)? Arguments like people will get ‘dependent’ on coverage that the government might not fund later…. that’s so insane! Lives could be saved, people will be more productive at work! Maybe it won’t go on forever, but it will do a lot of good while it does happen. It literally will be life and death for some people. Are we such a cold, heartless, selfish state that we are willing to let people die just because we’re republican? Idaho is not perfect, but I’d like to think we at least CARE about other people! Would I pay a few dollars more in taxes so that other people can receive health care? YES!!!




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