How, Just How?

I don’t know if we all agree that folks with disabilities or low income should have access to health care services. I’d love to have that discussion.

It seems that our nation thought this, and so the Medicaid program was passed into law in 1965. But those were different times. Don’t ask me what I was under the influence of back then.

Medicaid was built as a federal-state partnership. If a state chose to enroll and abide by the federal requirements, the federal government would agree to pay no less than half of the cost, but no more than 80% of the cost. The target population back then was folks with severe disabilities and those under the federal poverty level (FPL).

Idaho might have had a different soul back then, because our legislature signed us up to enroll in Medicaid in 1966. We were an early state to enroll. Maybe the Freedom Foundation wasn’t born then. I was just twelve. It was a long time ago.

So that matching/ shared payment program applied to the traditional Medicaid folks. That matching formula (called the FMAP) is calculated every year based on the average income of the state’s residents compared to the national average.

Idaho has had a generous FMAP match for many years, often 70% federal, 30% State, based on our lower incomes. Most states are 50/50. This year we get a bump. Our state income went up. This year we will now have to pay 2% more.

For those of you here in Idaho still burning about Medicaid Expansion, this is NOT a flag to wave. I know, this is complicated and confusing, and you probably don’t even care. But how, just how are we going to get this done? Please, pay attention and understand the details.

The Medicaid Expansion population will always be supported federally at 90%. The state will only have to pay 10% of that cost. This FMAP bump only applies to those below 100% FPL and the disabled. Believe me, those folks are expensive, but deserving of our care.

I write this to teach, but also to learn. I went to a forum tonight where my local legislators were talking to the crowd about their plans for the coming legislative session. I asked if they had any reaction to this FMAP change. NEITHER representative even knew what I was talking about. NEITHER knew how Medicaid is funded.

So, I wish to ask the crowd, should we be providing healthcare to the disabled and poor? If not, just say so, and a simple vote by you legislators who represent me could disenroll us from the Medicaid program. I can write the bill for you.

But if not, if you think people with disabilities and those who don’t get health insurance from their work should have access to health care, then how, just how are we going to do this?

I have read many other plans. The Idaho Freedom Foundation foisted one a few years back when they were opposing Medicaid Expansion. It proposed everybody have a health savings account. I guess they hadn’t read that 60% of us couldn’t finance a blown transmission let alone cancer.

Paul Ryan, remember him? He quit being Speaker of the House right after he got the Trump Tax Cuts through. Maybe he saw the folly. Maybe he saw a more stable job. But his argument was to replace the Medicaid formula with block grants.

I was just entering state politics at the time. I saw the value in his proposal. Look carefully at the formula. If Idaho figures out how to save a ton of money on Medicaid, we only get 30% of the savings. Block grants would build in more incentive.

But then I spent some time in the Idaho legislature. Sorry. I was not impressed.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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