It’s been a big week in Boise. In the Senate, they focused on the voter initiative process. In the House, it was Medicaid.

Both of these issues sucked up a lot of oxygen and raised a lot of questions. As you probably know by this point, I voted “no” against the Medicaid bill that came to the House.

Below you’ll find the column I asked the Post Register to publish today. It outlines the financial consequences of HB277 for Madison County, and the reasons for my vote. I know that not everyone will agree with those reasons, but I hope you’ll ask questions if you have concerns.

We’ve debated Medicaid expansion for years in Idaho. On Thursday, that debate came to a head with HB277. My vote came down to one question. Did HB277 serve the best interests of Madison County?

Madison County isn’t like other Idaho counties for many reasons. But this debate put one reason front and center: Madison Memorial Hospital.

One of seven county-owned hospitals in the state, bills that hurt Madison Memorial hurt the county’s taxpayers. This reality means weighing how any proposed Medicaid legislation impacts county-owned hospitals.

Medicaid Eligibility

HB277 includes a mandatory work program. We all appreciate the value of working. I know from firsthand experience the benefits of developing a strong work ethic. But because the program is mandatory, it will affect Medicaid eligibility if someone fails to comply with all the requirements. Affecting eligibility will result in people being removed from Medicaid, creating a new gap population that will still seek healthcare.  

Currently the law requires hospitals treat everyone who walks in the door, regardless of their ability to pay. A new gap population will leave Madison Memorial on the hook for 100% of all costs from these patients, even if they don’t reside in the county. If the hospital is on the hook, Madison County’s taxpayers are on the hook.

I voted “no” on HB277 because county taxpayers shouldn’t bear the financial burden of a new gap population.

Taxpayers on the Hook

Madison Memorial serves multiple counties. Between Madison, Jefferson, Fremont, Clark, Lemhi, and Teton Counties, an estimated 6,800 people will be eligible for Medicaid. If even 10% of this population ends up with eligibility issues, that’s 680 folks who will show up at the hospital for care without health coverage.

The average ER visit now runs $1,500-$2,000. Do the math. Assuming even one ER visit a year, it racks up almost $1.4 million in uncompensated care. Madison Memorial and county taxpayers will bear those costs.

Now, take those numbers and multiply them by seven. HB277 hands our county-owned hospitals and their taxpayers a multi-million-dollar bill. These numbers are not a worst-case scenario and don’t even begin to account for the costs of a single ER visit turning into an overnight stay. All those costs land right in the laps of county taxpayers.

There are multiple proposals to improve Medicaid expansion and generate additional savings. Some of those proposals are part of HB277 and would be great ideas in other bills. But the consequences of including an option that affects Medicaid eligibility outweighs any benefits for county hospitals and taxpayers.

Medicaid isn’t perfect, and I know you may not have voted for Proposition 2. But regardless of your vote, I doubt any taxpayer in one of these seven counties wants to foot a multi-million-dollar bill because of a decision we made in Boise. Going forward, I’ll continue to weigh all the options and their overall impact on our communities. In this instance, it meant making the call that HB277 wasn’t in the best interest of Madison County or its taxpayers.