Choose your Blandishment

“We look to the States to defend their prerogatives by adopting the simple expedient of not yielding to federal blandishments when they do not want to embrace federal policies as their own.”

Justice John Roberts in the Affordable Care Act Decision 2014

Blandishment:

  1. a flattering or pleasing statement or action used to persuade someone gently to do something.
    We get Federal matching money for state programs all the time. And of course, federal requirements come with them. Some of these funds we here in Idaho welcome, some we don’t.
    This morning in JFAC I heard of Federal Grants administered by the Governors Office of Drug Policy. And there was a federal grant to the the Idaho State Police that required a supplemental adjustment.
    Here is the relationship in our Idaho budget of Federal to State and other sources:
    General Fund=Idaho Taxes Federal Funds= Blandishments

    General Fund=Idaho Taxes
    Federal Funds= Blandishments

    I have been working for years to get my legislative colleagues to consider the proposition to change eligibility, so 78,000 working poor Idahoans could get health insurance coverage. There has been little interest in this solution; I am struggling to understand why. I learned something from a colleague the other night and I am grateful.
    I sit on the CAT Board and review the 200-300 cases annually. People with no insurance suffer tragic health events, treatment is provided, they are found indigent by their county, liens are filed and bankruptcy ensured, and the Idaho taxpayer pays the hospitals.
    One solution would be to enroll these folks in insurance, as the individual mandate in the Affordable Care Act requires. But if someone earns less than 100% of the Federal Poverty level, they are not eligible to buy subsidized health insurance on Idaho’s state exchange. These are the “Gap” folks. Enrolling them in Medicaid would mean we would be accepting the federal rules if we took the federal money. Thirty one states have taken this step. Idaho has not.
    We have events some evenings and I try to attend when I can. At one two nights ago I was milling around and ran into a very conservative colleague. We share an interest in developing broadband access and he had just learned of a federally supported program that would build out fiber to under served areas at a 10:1 match. If Idaho invested $5M, the Feds would dump in $50M. He was ecstatic to learn about this. I shared his enthusiasm. We need rural broadband in this state.
    Then I pointed out, we could get rid of the CAT fund and improve Idaho health care funding with an even higher match rate (20:1).
    He frowned. He knew what I was referring to.”Oh there you go again with that liberal Obamacare stuff. We can’t take that money because the Feds are bankrupt.”
    “Just a minute,” I caught his gaze and said honestly,” You just enthusiastically endorsed accepting federal money for broadband development, but refused it for health care. Can you explain to me how you make this distinction? I want to know.”
    “That Medicaid expansion is never gonna happen, not here in Idaho, you gotta know that.” He was trying to laugh me off.
    I kept my gaze on him and my voice as kind as I could. I even touched his arm.”Look, I really just want to know how you make this decision. How do you decide when is it OK to take federal money, and when isn’t it?”
    He looked away but I could tell he was thinking.
    “I guess I just decide based on what’s important to me.”
    I thanked him for his honesty.
    Improving the health, the well being, the prosperity of Idaho is very important to me. I believe covering this “gap” population ¬†with a health insurance plan would serve us all.

About ddxdx

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