Work for It

It seems our Governor is considering work requirements for Medicaid enrollees. He hasn’t done his research.

Or maybe he has, and this is a Trojan Horse, just waiting for the Idaho Freedom Foundation to roll it within its walls.

Do I need to remind you just what Medicaid is?

Okay, it’s a Federal/ State partnership to get people health insurance. States can enroll, but don’t have to. Idaho could disenroll at any time. Maybe Idaho would if those fire breathing IFF legislators got some cojones. Instead, they just want to grouse, kick dirt, and blame poor people for taking their money to get health insurance. Meanwhile, they get their health insurance paid for by us Idaho taxpayers to the tune of $15,000 a year. Makes sense, doesn’t it?

Anyway, it seems the Medicaid Expansion Initiative is still twisting the IFF legislators’ shorts. I hear it at town halls, I hear it when the budget is puzzled over. Heck, I hated seeing the climb in Medicaid costs when I served on the Joint Finance Committee. But maybe only Brad is seeing the big picture.

We have just kicked 120,000 Idahoans off Medicaid. That will make the Medicaid budget more palatable this year for the legislature. They don’t care that the vast majority of those kicked off don’t even know they have been. They’ll find out when their meds run out. And then we’ll pay for their time in the hospital, the ER, or the jail or prison.

When we cut Medicaid back in 2011 due to the economic downturn foisted on us by the big banks, I told my fellow Senators, “You can save money by not changing the oil in your rig. But it will cost you in the long run.” All those cuts did indeed cost more through increased indigent and ER bills.

So why is Brad talking about work requirements now? I have no clear idea. He doesn’t call me.

Work requirements have been tried in a few states. Idaho even has a work requirement application pending. It was not approved by Trump, nor Biden. But maybe now, Brad thinks. Or does he?

The Arkansas experiment is the only one with any good data. And it was brief, only lasting less than a year. But they successfully kicked 18,000 people off coverage. Those kicked off could have reapplied, but only 11% did. Sounds like a win for us taxpayers, huh?

Did you know that over 60% of people on Medicaid already work at least half time?

Did you know that having health insurance has a significant positive influence on getting employment?

Did you know that 25% of people on Medicaid have poor internet access?

Brad knows all this.

Put this all together and Medicaid work requirements starts to sound like another IFF library porn dog whistle. But our Governor blowing it?

Brad also knows, for Medicaid in Idaho to be a better program we need to invest in directing money to smart choices, not just writing checks for whatever bills we get. That will require some investment.

Blue Cross has rooms of people authorizing, or not, tests, procedures, medications. Idaho Medicaid doesn’t.

Let me digress. Idaho Medicaid had a computer algorithm that required any change in narcotic prescription had to go through the “prior authorization” process. I was trying to get a chronic pain patient to taper his narcotics. He finally agreed. I wrote a stepped down prescription for him. The pharmacy wouldn’t fill it because it needed to be “Prior Authorized”, even though it was a lower dose. So now he gets no meds, is in withdrawal, and he thinks I’m an idiot.

Maybe I was.

But sure enough, we can do better. Medicaid needs to be better. It can be.

About ddxdx

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