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What’s Idaho GOP’s next Medicaid excuse?

By MARTY TRILLHAASE (Lewiston Tribune)

When it came time to consider extending the Medicaid coverage Obamacare promised to some 78,000 low-income working Idahoans in 2012, here’s what we heard:

There’s no need to do that. Mitt Romney is going to beat Barack Obama in the November election. Then working with a Republican Congress, President Romney will repeal Obamacare.

The following year, when President Obama began his second term, all eyes in Boise shifted to another reason.

We’re going to pass a state-based health insurance exchange, which will help provide subsidized health insurance under Obamacare for those who earn enough to qualify. We can’t divide our political forces by also seeking Medicaid expansion for those who can’t afford the subsidized insurance.

Then in 2014, the message changed again.

We can’t do Medicaid now. It’s an election year – and everyone from Gov. C.L. “Butch” Otter down to the lowliest legislator faces the voters. Even worse, passage of the health insurance exchange riled up the right-wing base, and the party faces a civil war in the spring GOP primary.

By 2015, of course, the civil war was over. Led by Otter, the pragmatists had by and large defeated the insurrectionists and were now in a position to address Medicaid expansion – especially if they were willing to forge an alliance with legislative Democrats.

Not so fast. Haven’t you heard of the “Bedke Rule”? Look, the only way we’re passing Medicaid expansion is by carrying at least 36 House Republican votes. Otherwise, we risk another GOP civil war. And there aren’t 36 House Republicans willing to do it.

So how about 2016? Granted, there were more calls to “do something” for Idaho’s beleaguered working poor. But nothing changed.

Why would it? Look, Barack Obama is a lame duck. Let’s wait for the election. There’s hope for a Republican sweep of the White House and the Congress. Then Obamacare will be repealed. Problem solved.

Which, of course, is where Idahoans found themselves this year. For three months, lawmakers dawdled. They could not even agree on a modest $10 million program to help the uninsured.

In fact, the state’s intransigence on Medicaid expansion was held up as a model to the nation in a recent Washington Post profile.

No need to do anything this year, not when President Donald Trump and House Speaker Paul Ryan are getting ready to repeal and replace Obamacare.

Well.

After House Freedom Caucus members, notably including Congressman Raul Labrador, R-Idaho, refused to budge, Ryan and Trump Friday realized they lacked the votes and threw in the towel on their repeal and replace strategy.

“I don’t know what else to say other than Obamacare is the law of the land,” Ryan said. “And, so, yeah, we’re going to be living with Obamacare for the foreseeable future.”

That came within days of the Idaho Legislature wrapping up its 2017 session, so don’t expect a quick turnaround.

But think what has been squandered.

Idaho is about $350 million poorer. That’s how much money the state forfeited by not implementing Medicaid expansion in 2014, 2015 and 2016 – the years when the federal government offered to pick up 100 percent of the program’s costs. The feds then planned to pay 95 percent of the cost through 2018. Idaho is about to blow that, too.

After that, the state can expect no more than 90 percent of the program’s costs to be covered by the federal government.

Based on research from other states, it’s likely 368 Idahoans died prematurely every year because they lacked access to the preventive health care services Medicaid could have provided them.

What the state spends on bills incurred by the medically indigent is still running about $34 million a year – even after some 87,000 people qualified for subsidized health insurance through the exchange. Medicaid expansion would have erased virtually all of the rest.

And by delaying, the state also has lost some of its expertise. Last year’s elections eliminated two physicians from the Legislature – Sen. Dan Schmidt, D-Moscow, and Rep. John Rusche, D-Lewiston. This summer, Idaho Health and Welfare Department Director Richard Armstrong will retire.

So when the 2018 Idaho Legislature convenes, it will confront Ryan’s reality: Obamacare will be the “law of the land … for the foreseeable future.”

By then, lawmakers will need a new excuse for leaving 78,000 people out in the cold for another year. – M.T.