Research & Commentary: Idaho Medicaid Expansion

Published October 10, 2012

In the wake of the Supreme Court’s decision on the Patient Protection and Affordable Care Act (popularly known as Obamacare), Idaho, like other states, must now decide whether to expand its Medicaid program by accepting a larger federal subsidy.

As passed, the federal health care law required states to expand their Medicaid eligibility to all individuals with incomes less than 133 percent of the federal poverty level or no longer receiving federal Medicaid. The Supreme Court, however, ruled states could not be required to expand their Medicaid programs in order to continue receiving current levels of federal support.

Those in favor of expansion say it will allow for more of Idaho’s neediest residents to receive better access to care. Those against expansion say the program is unduly expensive and traps people in a cycle of dependency. The Idaho Freedom Foundation states, “The Medicaid safety net has become a hammock, with many Idahoans staying entrenched in the system forever. In fact, the Department of Health and Welfare refuses to track how long people are utilizing Medicaid or finding ways to get people off government assistance.”

Currently Idaho has 236,000 Medicaid patients, who cost the state’s taxpayers more than $437 million per year. A study conducted by the Utah consulting firm Leavitt Partners found expansion would increase the state’s Medicaid rolls by 40 percent, adding 100,000 people to the program. Although the federal government will front the majority of the bill for expansion, full federal coverage of new enrollees will end in 2020, leaving the state to finance the difference.

This massive increase in a system that already provides insufficient care will not guarantee better health care access to Idahoans. Instead, it will guarantee longer waiting lines for patients and huge costs for taxpayers. Idahoans should be wary of further expanding a system that is fiscally unsustainable. Instead, policymakers should focus on fixing Medicaid for the patients already in the system.

The following documents offer additional information about Medicaid expansion.

Increasing Dependency Is Not Compassion
The Idaho Freedom Foundation describes the condition of the state’s Medicaid program and the additional fiscal ramifications expansion would incur.

Idaho Report on Government Waste
In a comprehensive study, the Idaho Freedom Foundation identifies the areas of Idaho’s state government where there is waste, fraud, and abuse.

Medicaid: To Expand or Not To Expand
Nicole Kaeding of Americans for Prosperity argues states should avoid expanding their Medicaid programs because doing so would support the flawed and expensive federal health care law, place heavy financial burdens upon the state, and expand an already-broken system.

Research & Commentary: States Should Avoid Medicaid Expansion
Kendall Antekeier of The Heartland Institute explains the Supreme Court ruling on Medicaid expansion and urges states to avoid expansion. “States should think twice about giving up more control of their Medicaid programs only to further expand a system that is already fiscally unsustainable,” she writes.

Ten Principles of Health Care Policy
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems.

The End of Federalism: How Obamacare Will Impact States
A fact sheet from The Heritage Foundation outlines the consequences of expanding Medicaid programs to match federal requirements.

Mario Loyola: Challenging the Constitutionality of Obamacare’s Medicaid Expansion
In a podcast for Coffee & Markets, Mario Loyola describes why he and many other analysts consider the federal health care law’s Medicaid expansion to be unconstitutional.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at

If you have any questions about this issue or the Heartland Web site, contact Heartland Institute Manager of External Relations Kendall Antekeier at [email protected] or 312/377-4000.