Bringing the Economy Home

Could A “Third Option” Make Medicaid Expansion More Palatable In Idaho?

Emilie Ritter Saunders / StateImpact

Idaho's 2013 legislative session is expected to wrap up Friday.

In total, Idaho lawmakers took more than 15 hours of floor debate this legislative session to determine that Idaho should create a state-based health insurance exchange. It was an act of compliance with the federal health care law that raised the hackles of many conservative Idaho lawmakers. The law’s optional Medicaid expansion — which by some assessments could prove trickier and more divisive than the health exchange debate — will not come up this session.

Times-News reporter Melissa Davlin points out that the delay could turn the Medicaid expansion into a litmus test for Republican lawmakers next year, when fall elections loom. 

House Speaker Scott Bedke, R-Oakley, said last week the 2013 Legislature won’t consider Medicaid this year, but waiting a year will change the politics of the issue entirely. Next year is an election year, and lawmakers may be wary of voting on a controversial Obamacare-related issue in the spring when faced with a May primary challenge from within their own party. — Times-News

In light of all of that, we’re taking note of a piece from NPR health policy correspondent Julie Rovner that aired on Morning Edition today. It highlights what Rovner terms a “third option” for states: the option to buy private health insurance. As Rovner reports, the federal Department of Health and Human Services last month gave Arkansas approval to use federal Medicaid expansion money to purchase private health insurance plans.

Rovner suggests it’s a middle path that could prove more palatable in conservative states like Idaho that have so far held off on coming to a decision, or rejected the option to expand Medicaid eligibility to 138 percent of the federal poverty level.

Here’s an excerpt from Rovner’s story that gets at the practical implications of this option:

“We have to … recognize that it will cost more,” said Austin Frakt, a Boston University health economist. “You don’t get something for nothing.”

But Frakt concedes that paying somewhat more — how much more remains a subject of contention — might not be all bad.

“One of the basic critiques of the Medicaid program is they pay providers too little and that’s why too few of them participate,” he said. So putting people in private plans with higher provider payments could help address those access problems.

Meanwhile, Medicaid watchers say proposals like the one in Arkansas could solve other problems — for the new Medicaid recipients and for the others who will be buying coverage in the new exchanges. — NPR


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