The share of Oregonians and Washingtonians without health insurance has dropped dramatically under Obamacare. The uninsured rate is now at a historic low in the West Coast states.
Idaho has missed out on that trend, largely because the state until now has refused to expand Medicaid eligibility on the federal dime. Idaho's Republican-controlled legislature was teetering Friday on whether to end its holdout.
‘Over 1,000 deaths in this state’
State legislators get accused of a lot of things. But it's very rare for them to be accused to their faces of killing their fellow citizens.
Last month, Dr. Kenneth Krell, director of critical care at Eastern Idaho Regional Medical Center in Idaho Falls, addressed an Idaho Senate committee.
“Nearly one patient per day dies in this state as a result of not having Medicaid expansion,” Krell stated. “That’s a direct result of that failure to obtain care at a stage when the disease process could be treated effectively.”
“The Idaho Legislature is unfortunately responsible for those deaths,” Krell continued. “Our intransigence in failing to pass Medicaid for the last three years has probably resulted in over 1,000 deaths in this state. And I see those patients on a nearly daily basis.”
Some lawmakers did not appreciate being told they “have blood on their hands,” though Krell and others making the point did not back down through the session’s end.
“Let me put it this way. My father always said you draw more flies with honey than vinegar,” Republican Idaho House Majority Leader Mike Moyle said. “Sometimes when you come in and make those accusations, it doesn’t help your cause.”
“Having said that, we all know that there is an issue that needs to be addressed,” Moyle added. “We’re trying to work toward a solution.”
Minding the ‘gap population’
The focus of lawmakers and protesters are the working poor who earn too much to qualify for government-paid health coverage, but don’t make enough to buy discounted insurance in the marketplace. The size of this so-called “gap” population in Idaho is estimated around 78,000.
As the hours of the 2016 session ticked down, the Idaho Legislature softened its past resistance to expanding Medicaid to cover this gap population. The federal government would pay for nearly all the cost under a major provision of Obamacare.
The state Senate voted 27-8 Thursday to ask the federal government for a waiver that would allow Idaho to redesign its Medicaid program to improve efficiency in advance of expansion. And then the Senate moved to adjourn for the year and left the state House with a take-it-or-leave it decision Friday.
If the House concurs, the 2017 Legislature would still get to review the refashioned health care program before it enrolled people from the uninsured population.
“In my campaign I promised that I would do what I could to repeal Obamacare,” state Rep. Ron Nate, R-Rexburg, said during an initial round of debate on Wednesday. “This is the opposite of repealing Obamacare. This is getting us right up to the final step of Idaho fully adopting every single part of Obamacare.”
The Idaho Freedom Foundation urged Idahoans to tell their legislators to “reject more Obamacare in Idaho.” Fred Birnbaum, vice president at the conservative public policy shop in Boise, worries the state could eventually be saddled with an unaffordable entitlement.
“The question in my view is, do you expand a program that is potentially not sustainable and add a population that is not as vulnerable as the base population,” Birnbaum said. “It could actually threaten the traditional Medicaid population given that the federal government is $19 trillion in debt.”
Birnbaum said IFF supports measures to deregulate the insurance market to permit lower cost coverage options and individual savings accounts in which able-bodied poor adults could put in money matched by non-profits and the state to buy private insurance.
Big declines in uninsured Northwesterners
Oregon and Washington state expanded Medicaid in 2014. Medicaid eligibility was raised in the neighboring states up to 138 percent of the federal poverty level. According to the Washington State Health Care Authority, 589,000 people have gained Medicaid coverage under that change cumulatively.
"We blew past any of our estimates very quickly,” HCA spokeswoman Amy Blondin said. “There was a lot of need out there."
In 2013, the percentage of the population that did not have health insurance stood in the mid- to high teens in all of the Northwest states. By late last year, that number had been cut by more than half in Washington and Oregon.
“We saw a decline in the state of Washington from 14.2 percent uninsured to 7.3 percent. It has been dramatic in the reduction of the people who are uninsured,” Washington state’s Democratic Insurance Commissioner Mike Kreidler said. “By far, the number one reason for that to take place was the expansion of the Medicaid program.”
Idaho experienced a rather small drop by comparison by only agreeing to the online health coverage marketplace part of Obamacare with the federal subsidies.
Idaho Governor Butch Otter said he wants a solution for people who fall through the gaps on health coverage. But he said Wednesday he would not act unilaterally to expand Medicaid eligibility using executive authority as the governors of some other ‘red’ states have done – including Alaska, Iowa and Nevada.
‘Do you have health insurance?’
According to the Gallup polling organization, 15.2 percent of Idahoans did not have health insurance at the end of 2015. That compares to 19.9 percent in 2013. The comparable numbers for Oregon are 7.3 percent in 2015, down from 19.4 percent in 2013 and in Washington 7.4 percent, down from 16.8 percent in 2013. Gallup counted respondents who answered no when asked, “Do you have health insurance?”
The latest estimate of the uninsured rate from the Oregon’s Health Authority based on different data sources -- including actual insurance program enrollments -- is 5.6 percent. Washington’s Office of the Insurance Commissioner used the U.S. Census Bureau’s American Community Survey to arrive at an uninsured rate of 7.3 percent at the end of 2015, which is within the margin of error of Gallup’s number.
Gallup’s survey analysis identified multiple factors driving down uninsured rates. Foremost was the option to expand Medicaid eligibility. In addition, the Affordable Care Act -- better known as Obamacare -- spurred the creation of state and federal health insurance marketplace exchanges. The ACA also allowed young adults to stay on their parents’ insurance policy until the age of 26.
The improving economy could be another factor in play as formerly unemployed people take jobs that offer health benefits.