Guest Editorial Series: Question the Medicaid Expansion Projections

By Bryan Smith

It’s long been said, though the wise learn from experience, the super-wise learn from others’ experiences. I believe that. Thus, I urge all Idaho voters to diligently examine the effects of Medicaid expansion in other states.

The backers of the proposed costly Medicaid expansion plan present it as a panacea for almost everything that ails the Gem State. They promise incredible coverage for the uninsured and the creation of thousands of jobs, all with no impact on existing government services like education and road repair.

I’m not buying what they’re selling. Neither should you.

Across the country, 32 states and the District of Columbia have expanded Medicaid to primarily abled-bodied, childless adults as part of Obamacare. In the run up to expansion in each state, government officials and third-party groups projected enrollment numbers. These projections were used to sell expansion to voters, as well as make critical public policy and budget decisions.

Unfortunately, most of the projections were wrong, and wildly so, to the detriment of taxpayers. According to a January 2018 report by the Foundation for Government Accountability, California’s enrollment has exceeded early estimates by more than 320 percent. Likewise, enrollment in Colorado has exceeded projections by more than 100 percent.

This mathematical-sleight-of-hand matters because higher enrollments lead to higher-than-expected costs for taxpayers. Let’s look at projections in our own backyard. A 2016 report commissioned by the Idaho Department of Health and Welfare guesses that expansion would cost Gem State taxpayers more than $220 million between 2021 and 2026. State officials project expansion in Idaho would cover more than 62,000 low-income individuals.

But, what if the estimates are wrong and Idaho, like most other expansion states, exceeds enrollment projections? If Idaho officials are incorrect, as many other states have been, and enrollment is higher than projected, the error would be a multi-million-dollar mistake with devastating impacts.

Foundation for Government Accountability research paints a much different picture about Idaho’s projected expansion enrollment and the associated costs. The foundation has concluded that Idaho’s expansion enrollment would be 35.2 percent higher than state officials predict. Translation: Idaho would extend coverage not to 62,000 people as forecast by state officials, the actual number would be nearly 84,000 people.

Regardless of which enrollment number is used, Medicaid expansion would gobble up a significant chunk of the state’s growing budget. The cost to cover the additional 22,000 people would take the five-year cost estimate from $223 million, as calculated by the accounting firm Milliman, to roughly $345 million. In sum, using FGA’s 84,000-person enrollment figure, its analysts predict that Idaho’s 10-year expansion costs would jump by 55 percent. That’s a startling figure for a state with a relatively small budget.

Compounding the potential cost problem above, we have the federal wild card: The above cost figures to Idahoans depend on the federal government keeping its funding promise. Currently, the feds would cover 90 percent of the bill for the new enrollees, and the would state pick up the rest. What if the federal government dropped the matching payment ratio to that of the traditional Medicaid population, where Idaho shoulders roughly 30 percent of the cost and Uncle Sam pays only 70 percent? The consequences would wreak havoc on the state budget.

In short, Medicaid expansion is fiscally dangerous. No one is certain how much the plan would cost you, the taxpayer, or how many people might enroll in the program. Even if someone could accurately predict those two figures, we can’t be certain that the debt-ridden federal government will maintain its promised Medicaid spending levels.

Regardless, any blend of the above endangers funding for the state’s top priorities. A massive spike in the Medicaid budget could mean fewer dollars for your kids’ classrooms, less money for road repairs, or higher taxes on hardworking families—or some combination of the three.

Let’s learn from other states’ mistakes. We can avoid the fiscal hardships that come with Obamacare expansion.

*Bryan Smith is the second vice chairman of the State of Idaho Republican Party and the fourth vice chairman of the Bonneville County Republican Central Committee.

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