COEUR d'ALENE - The most impoverished segment of Idaho's uninsured adults will remain without any health care coverage if lawmakers fail to expand the state's Medicaid program.
It could also prove costly to Idaho's big businesses.
Idaho Kids Count, a nonprofit community resource organization, issued a report Monday illustrating the impact not expanding Medicaid will likely have on the state's most vulnerable families.
"We want people to understand," said Idaho Kids Count Director Lauren Necochea.
The Idaho Kids Count report describes two families of four. In one family, the father works full-time as a maintenance worker and the mom stays home with the kids. Their annual income is $31,680. They will receive a tax credit of $10,206 to help them purchase health insurance.
The other family of four's annual income is $23,155. The father is an office clerk and the mom works part-time as a home health aide. This family is ineligible for any tax credit.
Idaho is among 21 states that have thus far opted out of widening their Medicaid rosters, and accepting the federal dollars that come with the expansion.
Last year, Gov. Butch Otter convened a Medicaid Expansion Workgroup that met three times and evaluated the issue. None of Kootenai County's state legislators were part of the group.
In its final report, the workgroup recommended expanding Medicaid to the state's "working poor," provided the increased eligibility includes "personal accountability" requirements. The recommendation also calls for a redesign of the way services are delivered.
As it stands, without Medicaid expansion, the Affordable Care Act will provide a federal subsidy, in the form of tax credits, to those earning between 100 and 400 percent of the federal poverty level.
"People who earn less than 100 percent of poverty are in 'policy limbo' at the moment; the law currently does not provide them with a subsidy," states the workgroup's final report. "Until the June 2012 Supreme Court decision, lawmakers assumed all states would take part in expansion."
The Associated Press reports that the Idaho Association of Commerce and Industry says that without Medicaid expansion, Idaho's large companies that don't insure their employees will face penalties of $12.3 million to $18.5 million per year.
Under the Affordable Care Act, companies with at least 50 full-time workers have to decide whether to purchase insurance for them or face fines.
According to the AP report, the IACI estimates that large employers could save millions if their lower-paid employees were able to enroll in Medicaid.
Rep. Frank Henderson, R-Post Falls, and Sen. John Goedde, R-Coeur d'Alene, each said they expect that Medicaid expansion will be discussed further in the Legislature.
"There's been debate on how much savings it will provide the state of Idaho and local governments," Goedde said.
Idaho counties received 6,000 applications from individuals seeking medical assistance in 2012. The final report by the governor's Medicaid Expansion Workgroup found that nearly all of those applicants, 90 percent, would be eligible for health care coverage if Idaho's Medicaid program is expanded.
In 2012, Kootenai County spent $3.4 million on its medically indigent program. That includes $324,000 to administer the program, and $342,000 for involuntary police holds.
The workgroup report also indicates that 50 percent of the uninsured, low-income patients now being treated at Community Health Centers, like Dirne in Coeur d'Alene, would be eligible for health care coverage if the state expands Medicaid.
An estimated 104,000 Idaho residents would qualify for Medicaid if the program's eligibility is widened.
The federal government is expected to foot the entire bill for the first three years, with Idaho eventually becoming responsible for 10 percent.
The Associated Press contributed to this report.