Some legislators are insisting that Medicaid expansion—enacted by 60.6 percent of the Idaho electorate—should be modified to include “work requirements.”
The evidence tells us that work requirements have failed wherever they’ve been tried. Consider recent news from Arkansas: Rather than fulfilling their promise to make people more productive, work requirements resulted in nearly 17,000 people losing coverage.
But there’s a more important reality for legislators to understand about work requirements: Idaho can’t afford them.
Kaiser Health News has estimated that Kentucky’s work requirements will cost $187 million in the first six months alone. In Idaho, a smaller state by population, costs would be less but still exorbitant.
Why? First, Idaho would have to spend millions to build a new layer of bureaucracy tasked with monitoring the lives of Medicaid recipients.
Second, evidence from other states suggests that work requirements could leave 10,000 or more Idahoans uninsured. This means that taxpayers would foot the bill for the emergency care of thousands of uninsured Idahoans.
One of the great benefits of a simple, unmodified Medicaid expansion is that it allows Idaho to scale down its wasteful system of emergency care for the uninsured. The nonpartisan Milliman Report has estimated these savings at $40 million per year.
If we leave thousands uninsured, we lose millions in savings.
Combine the cost of emergency care with the costs of constructing a heavy-handed bureaucracy, and the total bill for work requirements adds up to millions—and perhaps tens of millions—per year. Where would that money come from? Last week at the capitol, a meeting of the Joint Finance-Appropriations Committee revealed that Gov. Brad Little did not set aside money in his proposed budget for work requirements. The meeting also revealed that the federal government is not likely to foot the bill.
This means that the only way to fund work requirements would be to raid the state general fund. Legislators are left with a choice to make: In a tight budget year, will they sideline priorities such as infrastructure and education in order to fund an unnecessary layer of bureaucracy?
Strangely, some continue to insist that “work requirements” would make Medicaid expansion more fiscally responsible. The truth is that Medicaid expansion without modifications—the law that 60.6 percent of the voters enacted—is the most fiscally conservative option. The start-up cost of Medicaid expansion will be just $10.8 million. As recently pointed out by Lauren Necochea, Director of the Idaho Center for Fiscal Policy, this amounts to just one quarter of one percent of the overall state budget.
Furthermore, Little has said that this funding can be easily secured by tapping the Millennium Fund, Idaho’s tobacco-settlement endowment. The Millennium Fund option gives legislators an opportunity to implement Medicaid expansion while leaving the state general fund untouched.
We needn’t worry about the cost of expansion. Instead, we should worry about the cost of a heavy-handed bureaucracy combined with the emergency costs of thousands of uninsured Idahoans. Simply put, Idaho can’t afford work requirements.