Idahoans voted to expand Medicaid by 60.6 percent. The idea that the legislature should pass a “clean” expansion without controlling costs is like giving your college student a credit card—a recipe for disaster.
Let us find an Idaho solution that works for everyone and does not burden Idaho’s overall budget. It is important for recipients to have some financial participation in the process and personal responsibility to encourage patients to seek more value for their care.
Here are a few ideas about how to expand Medicaid to the working poor.
Offer free-market solutions, too. Allow eligible recipients to purchase policies on the www.youridahohealth.org exchange. Currently, people who earn less than $12,000 a year can’t purchase policies on the exchange. Allowing folks to purchase plans on the exchange would also put them in charge of their care and pocketbook. This will also encourage patients to seek more value. As the recipients earn more, they will be kicked off of Medicaid, which could interrupt their healthcare. A market-based option would provide easier transitions as people grow their way out of poverty.
Allow people to purchase catastrophic health insurance policies that meet their needs and not require all of umpteen requirements that the Affordable Care Act forces on everyone.
Require Medicaid Expansion recipients to pay small monthly premiums and co-pays. This would encourage people to spend wisely. Adding things like higher co-pays for non-emergency visits to ERs would also help control costs. This is a better option than having work requirements, which are expensive for the state to administer. Structure the expansion in a way that it is a help up rather than a hand out. Help recipients transition off of Medicaid and onto the health exchange or into a catastrophic policy so they don’t have gaps in health insurance and healthcare. When one is struggling to get out of poverty, having the peace of mind that you are covered if some medical crisis emerges gives hope.
Encourage patients with chronic illness to develop a relationship with a primary care doctor to help manage their illnesses to hopefully avoid down-the-line serious surgeries for things like amputations due to complications from diabetes.
There are good reasons to expand Medicaid for the working poor. Expanding Medicaid will bring more federal dollars to pay for indigent care from the county on up. The biggest and best reason is that an estimated 62,000 people (in that gap between not being poor enough for Medicaid and not making enough to buy insurance on the exchange) will have access to healthcare!
There are also good reasons not to simply expand Medicaid. There are few incentives to control costs in the current system. The Medicaid billing and claim system is poor, antiquated and costly, which contributes to upward pressures on healthcare costs and insurance premiums.
In closing, our entire healthcare system needs a major overhaul to control costs and provide quality healthcare while steering away from costly government-sponsored care. There needs to be pricing transparency and transparency of quality of services provided so that all of the stakeholders—i.e., taxpayers, caregivers, carriers and patients—get fair value and patients receive quality services. Let us find practical, workable ways to expand Medicaid.
Julie Lynn is a Ketchum resident
