Idaho Group Sues to Block State’s Medicaid Expansion

Published December 27, 2018

The suit, brought by the Idaho Freedom Foundation, says the expansion— which was passed through a ballot initiative during the 2018 election—is unconstitutional and that the state would be required to expand the program without the legislature having appropriated any funding for it.

Contradiction of Federal Law?

Fred Birnbaum, vice president of the Idaho Freedom Foundation, says the language of the initiative is “legally dubious.”

“The ballot initiative language says a couple of major things that we believe are legally dubious and should be challenged in court,” Birnbaum said. “The sections of the [federal] Social Security Act are those that describe eligibility, and they could be changed by Congress, … basically saying the state is going to raise the eligibility [while still] allowing the federal government to change the eligibility. … So, if the federal government, through an act of Congress, changes that eligibility, then the state is on the hook, the way this ballot initiative is written. That’s one major issue.”

The second big flaw is the “unconstitutional” delegation of legislative authority to the Idaho Department of Health and Welfare, Birnbaum says.

“In another section of the ballot initiative, it says, ‘no later than 90 days … the department is required and authorized to take all necessary actions,'” Birnbaum said. “By saying this, it requires and authorizes [the Idaho Department of Health and Welfare] to take all actions necessary to implement. There is no limitation.

“It doesn’t just say to initiate; it says to implement,” Birnbaum said. “Before there’s even money appropriated, the plan amendment could be written and implemented [regardless of whether the legislature funds it]. … We believe that’s an unconstitutional delegation of legislative authority from that branch to the executive branch.”

Unexpectedly High Costs

In a July 2018 report on the potential impact of expansion, the Idaho Department of Health and Welfare determined the plan would initially cost the state $45 million per year. The state would pay 10 percent of the total costs of the expansion, with the federal government covering the other 90 percent, the report noted.

“More than 30 states have expanded [Medicaid],” Birnbaum said. “The cost, on average, has been more than double [what was] expected. We were concerned that expanding Medicaid to able-bodied people would have them competing for services with the truly needy, children, disabled, and those concerns have not gone away. We still have the financial concerns and crowded-out care for the truly needy.”

More Insurance, Less Care

Medicaid expansion reduces the availability of health care for those who really need it, says Dr. Deane Waldman, director of the Center for Health Care Policy at the Texas Public Policy Foundation.

“The experience from New Mexico proves what happens with expansion,” Waldman said. “Watch out, Idaho.” In 2012, the Budget Oversight Committee of the New Mexico Legislature estimated the cost and enrollment effects of Medicaid expansion under the Affordable Care Act through 2020, and then the state expanded its Medicaid program in 2013. By 2016, New Mexico had already hit the cost and enrollment predictions for 2020, and analysts predict nearly 50 percent of the state’s population will soon be enrolled in Medicaid.

“New Mexico Medicaid had a $417 million budget shortfall,” Waldman said. “To balance the New Mexico Medicaid budget, they had to reduce M.D. reimbursements. This reduced the number of medical doctors willing to accept new Medicaid patients. As a result of expansion, [there are] more patients with insurance and fewer providers. The net effect of expansion: more spending and less care available.”

‘Insufficient and Ineffective’

Waldman says it is clear national, onesize-fits-all reactions to state-specific health care problems don’t work.

“That kind of care is both insufficient and ineffective, and government insurance is unaffordable,” Waldman said. “The last thing people in Idaho need is Washington, DC controlling their health care.”