Medicaid expansion protects Idahoans during difficult times.

Medicaid Expansion Is Not a Budget Buster—It’s a Lifeline

Let’s talk about Medicaid. In Idaho, Medicaid provides health coverage for four main groups of people: children and pregnant women, individuals with disabilities as determined by Social Security, elderly individuals in nursing homes, and low-income adults whose household income falls below 138% of the federal poverty level. When we talk about Medicaid Expansion, we are specifically referring to that fourth group—adults who, despite working hard, don’t earn enough to afford private health insurance.

When the Affordable Care Act (Obamacare) passed in 2010, it included funding to ensure all Americans making below 138% of the poverty level would be covered under Medicaid. However, because Medicaid is a state-run program that receives federal funding, some states challenged the expansion in court. In a 5-4 decision, the U.S. Supreme Court ruled that the federal government could not force states to expand their Medicaid programs. That left the decision up to individual states.

For years, the Idaho Legislature refused to expand Medicaid, despite growing public support. Finally, in 2018, frustrated Idahoans took the issue directly to the ballot box. By a margin of nearly 61%, voters approved Medicaid Expansion, ensuring health coverage for tens of thousands of working Idahoans who would otherwise be uninsured.

Since then, some have argued that Medicaid Expansion is too expensive and that it threatens Idaho’s budget. The truth, however, tells a different story. The federal government covers 68% of the costs for traditional Medicaid recipients—children, pregnant women, those with disabilities, and the elderly in nursing homes. For the expansion group, the federal government pays 90%, leaving Idaho responsible for just 10%.

According to the Idaho Legislative Services Office Budget Book, the total cost of all Medicaid programs in Idaho for the current fiscal year is $4.68 billion. Medicaid Expansion accounts for $1.08 billion of that. But after the federal government’s contribution, Idaho’s actual cost for Medicaid is $856 million, and for Medicaid Expansion alone, just $108 million.

To put that in perspective, Idaho’s total state budget for the year, excluding federal funds, is $5.18 billion. That means Medicaid makes up 16.5% of the state budget, while Medicaid Expansion accounts for only 2.1%. That’s not an out-of-control program; that’s a modest investment in the health and stability of our communities.

Supporters of House Bill 138 claim it introduces “guardrails” to Medicaid Expansion, but in reality, it imposes unrealistic requirements that would eventually lead to the program’s repeal. If that happens, nearly 90,000 Idahoans—our neighbors, coworkers, and friends—would lose their health coverage. Proponents of the bill argue that Medicaid Expansion is unsustainable, that it is growing too fast, and that we must rein it in before it consumes the state budget. But Idaho can afford 2.1% of its budget to ensure that hardworking people don’t fall through the cracks.

Imagine you’re doing everything right—working full-time, budgeting carefully—but inflation is making it harder and harder to keep up. Your grocery bill, your rent, your utilities, and your gas costs keep rising. Health insurance? That’s a luxury you can’t afford. The cheapest plan on the exchange costs over $500 a month, with an $8,000 deductible—so high that even if you had insurance, you couldn’t afford to use it. Your kids qualify for Medicaid, but you and your spouse have no coverage. And every day, you worry. One car accident. One broken bone. One unexpected illness, and you could be financially ruined.

Medicaid Expansion is a safety net that exists for precisely these moments. It doesn’t cost the state anything if people don’t use it, but it provides security and peace of mind when they do. It allows people to focus on working and improving their lives rather than living in fear of medical bankruptcy.

On average, Idahoans stay on Medicaid Expansion for just nine months—just long enough to get through a tough time and move forward. Medicaid Expansion isn’t a permanent entitlement; it’s a temporary bridge for those who need it.

The claim that Medicaid Expansion is a runaway expense threatening Idaho’s budget is simply not true. The scare tactics being used against it are just that—tactics. Medicaid Expansion isn’t about handouts; it’s about protecting hardworking Idahoans in the difficult moments of life. It is doing exactly what it was designed to do, and it should not be repealed. It’s working.