Lawmakers’ obvious top priority should be to implement and fund Medicaid expansion — with no substantial alterations to the language of Proposition 2.
The good news is that most legislative leaders don’t appear ready to demonstrate contempt for voters by reversing the initiative. The bad news is that some officials appear to be considering changes to the program voters chose.
Gov. Brad Little made a somewhat vexing statement at a legislative preview with journalists Thursday. He said he was committed to implementing Prop 2, but he cryptically added that it should be implemented “in an Idaho manner.”
He gave one hint of what that might mean: “We don’t want to have an incentive for people not to work.”
Work requirements for the Medicaid expansion population are being implemented in a number of states to address that concern, but the available evidence indicates they will waste taxpayers’ money, impose a bunch of complicated paperwork and result in lots of eligible, deserving people being booted from the program.
The vast majority of the gap population work, are in school or are actively seeking employment, meaning they shouldn’t be affected by a work requirement. But monitoring that population would require the construction of a large state bureaucracy: people to review paperwork, investigators to check in on recipients, supervisors to keep tabs on the investigators and clerks, and perhaps a new high-level position in the Department of Health and Welfare to oversee the program.
If lawmakers want to create an expensive state bureaucracy, they should be able to produce empirical evidence that such a bureaucracy would solve a real problem. But there’s no evidence there is a problem and less that work requirements would improve things.
There isn’t any evidence to support the concern that Medicaid expansion would cause people to choose not to work or reduce their hours, for example. A comprehensive literature review by the Kaiser Family Foundation, a nonprofit, nonpartisan research institution focused on health policy, in March found zero studies showing a statistically significant negative effect from Medicaid expansion on the employment rate, the rate at which people leave their jobs or the number of hours people work.
In a well-researched op-ed last month, Dr. Kenneth Krell pointed out that a recent study indicates between 0.3 and 0.4 percent of the expansion-eligible population in Idaho would run afoul of a work requirement, a fraction so small that it’s hard to justify creating an expensive bureaucracy. And in states that are moving toward work requirements, research indicates the vast majority of those booted off the Medicaid roles will lose eligibility not because they didn’t meet the work requirements but because they made errors in the complicated paperwork.
In other words, work requirements created more problems than they solved.
Little wants an Idaho solution? We’ve already got one, which nearly two-thirds of state voters backed, more than backed him. Proposition 2 is the law of the land, the will of the people, and it should simply be funded in unamended form. All other priorities should take second stage to this one.