Nobody roused a crowd talking about numbers. Images stir us. Just look at TikTok. But the numbers tell the truth. Maybe we just don’t want to know the truth.

The brouhaha about how Idaho’s budget committee (Joint Finance and Appropriations =JFAC) is deciding to spend taxpayers’ dollars needs a specific example for you to understand the folly.

It’s about numbers, not dead fetuses, or freedom, so you might not care. But that’s how this country has become the swamp it is. Us common folk don’t often pay attention to the numbers. Rich folk do. And so, they are rich. We all should do better.

Let’s drill down on the Medicaid “maintenance budget” that JFAC has just passed. I encourage you all to read the bill. You’ll have to get to page six to read the Medicaid budget. This bill has passed both the Idaho House and the Idaho Senate. All Republicans voted for it. All Democrats voted against. It awaits the governor’s signature.

Here’s the catch. That’s last years budget. They have not made any allowances for how Idaho or our relationship with the federal government has changed in the last twelve months. Theoretically, that bill with all the changes is to follow. That’s where our majority Republicans want to nitpick.

Then, the rubber will meet the road.

Last year’s regular Medicaid budget had a federal matching rate (FMAP) for regular Medicaid at 69.72%. This year’s will be at 67.59%.

I warned you about the numbers. They are going to get big.

That small change came about because Idaho became less poor. Idaho led the nation in median household income growth.

Medicaid is a partnership with the federal government to get people health insurance who don’t get it through their workplace. If the state is poor, the federal government forks up. If our incomes improve, the state is expected to pay more. Many states are at a 50/50 rate. We have been as high as 80/20. But our household incomes have risen in the last few years. So, we will need to fork over more if we want to keep this health insurance for our citizens.

Maybe we do, maybe we don’t.

Because when the next JFAC Medicaid bill comes to both houses it will include this FMAP change.

I’m sorry, but you must pay attention to the numbers, and the definitions.

I am NOT talking about the Medicaid Expansion population. That small group of Medicaid expense will never be more than a 10% match for the state. That’s why it was such a good deal.

But the regular Medicaid folks, the severely disabled and the children, and the pregnant women are the ones under regular Medicaid. They are the ones who will become more expensive. $68M more expensive.

Legislators are still butt hurt about Medicaid expansion. They throw numbers around with brazen ignorance and it can alarm you. I have seen my elected representative do this at town halls. But he is doing this to build an image. His numbers aren’t real. They aren’t the truth.

But when the real budget bill comes up for a vote on the floor of the Idaho House and Senate, will they know the numbers? Will they know the truth? I deeply regret to say, they will not. They do not understand the details of the budget. And few of us do.

But here’s the punchline in this numbers game. If the Idaho Republican legislative majority doesn’t approve the next Medicaid budget, with it’s $68M dollar bump for the regular Medicaid folks, Idaho will not be following our agreed upon partnership with the federal government. We will be in default.

Every year I was in the Idaho Senate, and on JFAC, and crafted the Health and Welfare budgets, I would watch the votes for the appropriations bills as they worked through. Medicaid might pass the House with a couple votes to spare. In the Senate it wasn’t as close.

This year, the “maintenance” budget has passed. The next budget bill with its bump will stick in their craw. And they will be voting us out of Medicaid.

And they can lie to you that they voted for it.

About ddxdx

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