Education’s stake in the Medicaid expansion debate

(UPDATED, 7:44 a.m. Thursday, Oct. 25, with more details.)

Education has emerged as one issue in the complicated debate over Medicaid expansion.

Two leading education groups have supported the initiative — Proposition Two on the Nov. 6 Idaho ballot.

Opponents say the expansion will drain dollars away from all other state programs, including education.

Before voters get the final say, here’s an overview.

Proposition Two: What is it?

The initiative would expand the Medicaid program to an estimated 62,000 Idahoans — known as the state’s “gap” population. People in the gap make too much money to qualify for Medicaid under the current law, but do not make enough money to qualify for insurance subsidies.

Supporters — armed with a long list of endorsements — say the federal government will pick up 90 percent of the cost, some $400 million. The feds’ money, and the expanded coverage, would help Idahoans receive preventive care, as well as care for life-threatening illnesses. “They’re working people and they deserve better,” Luke Mayville of the pro-expansion group Reclaim Idaho said during a City Club of Boise forum Tuesday.

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The Idaho Freedom Foundation is leading the opposition. The conservative think tank and lobbying group says the expansion would discourage people from working, and is not fiscally sustainable. “(It’s) a lifeline to prop up Obamacare’s failures,” Fred Birnbaum of the foundation said Tuesday.

The campaign is an extension of a six-year Statehouse debate over Medicaid expansion. The U.S. Supreme Court kicked the question of Medicaid expansion to the states in 2012, but Idaho legislators have resisted efforts to expand coverage. Frustrated, Medicaid expansion supporters gathered 56,000 signatures, and succeeded in getting the question on the ballot.

How does education fit into the debate?

For the better part of the past six years, education has been a non-topic in the Medicaid debate.

That changed this summer, when the Freedom Foundation and the Idaho School Boards Association engaged in a battle of guest opinions over the cost of Medicaid expansion — and the impact on education.

And the debate doesn’t just pit the Freedom Foundation against education groups.

During an Oct. 19 panel discussion on Idaho Public Television’s “Idaho Reports,” Rep. Thomas Dayley said the upfront cost of Medicaid expansion would jeopardize funding the fifth year of the career ladder, a five-year, $250 million plan to boost teacher salaries. The fifth year of the career ladder could carry a $52.9 million price tag.

“We will probably not be able to do the career ladder extension,” said Dayley, R-Boise. “That’s the dilemma we will be faced with.”

During the same panel discussion, Sen. Maryanne Jordan downplayed this concern. Jordan, D-Boise, says the Legislature could use one-time money to cover the upfront costs of expansion.

So what is the impact?

Medicaid expansion isn’t entirely free, at least at the state level. Even in year three of the expansion, the state would need to spend $44.6 million on Medicaid expansion, according to the nonpartisan Idaho Center for Fiscal Policy. State and local government would realize $40.3 million in savings. That means the state will need to pick up the difference.

However, the ISBA and the Idaho Education Association have both endorsed Proposition Two. Students with “robust access to health care” are more likely to succeed in school, the groups said in a joint statement on Sept. 18. And the ISBA believes Medicaid expansion would have an indirect benefit; as rural counties spend fewer property tax dollars on indigent and catastrophic medical care, voters would be more likely to approve school bond issues and tax levies.

And are there other effects? The Freedom Foundation argues that there’s a potential link between an increase in Medicaid spending and decreased higher education spending, citing a column in Education Next, published by the Harvard Kennedy School’s Program on Education Policy and Governance. But as Idaho Reports and the Idaho Statesman noted in an Oct. 14 article, author Douglas Webber downplayed the possibility of a causal link.

“It is unlikely that the Medicaid expansions provided for under the Affordable Care Act (ACA) are responsible for much, if any, of the decline in state higher-education funding,” Webber wrote in May.

Where do the candidates stand?

During a televised debate on Oct. 12, Republican state superintendent Sherri Ybarra refused to stake out a position on Proposition Two (or Proposition One, a horse racing initiative). Democratic challenger Cindy Wilson supports Proposition Two.

It’s the same story in the governor’s race. GOP Lt. Gov. Brad Little has repeatedly ducked questions on Proposition Two, saying only that he will honor the wishes of voters. Democratic candidate Paulette Jordan supports Proposition Two.

More reading: For the latest campaign news, with an education emphasis, go to Idaho Education News’ elections page

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