Medicaid for Idaho?

Idaho is a deeply red state—one of the most conservative in the country. Yet Idahoans have a fierce independent streak and do not like being told what they can and cannot do. A group of activists has collected signatures to put Medicaid expansion on the state’s ballot this November. Voters should get to decide, they argue, rather than a small group of legislators in Boise. These activists are gambling that expansion will pass on a popular vote.

We recently chatted about Idaho’s ballot initiative with Daniel Nelson, one of the activist leaders. He told us the story of two friends, Luke Mayville and Garrett Stirizich, creating the Medicaid for Idaho campaign in March 2017. They saw a disconnect between voters and the legislature on Medicaid expansion. They purchased a 1977 camper van, painted it green, emblazoned it with the words “Medicaid for Idaho,” and drove off to learn the health care stories of Idahoans across the state. Nine months later, they were convinced there could be enough momentum for expansion and they began the daunting task of collecting signatures to get on the ballot.

Nelson is a medical student at the University of Michigan who is taking a break to do a master’s degree in public policy at the Harvard Kennedy School. On election night in 2017 he was intrigued by Maine’s public referendum to expand Medicaid and excited to hear reporters say that a team in his home state of Idaho was working to do the same there. He immediately reached out to Mayville and Stirizich’s Medicaid campaign, looking for a way to get involved. He was later brought on as a policy advisor.

They purchased a 1977 camper van, painted it green, emblazoned it with the words “Medicaid for Idaho,” and drove off to learn the health care stories of Idahoans across the state.

“Being someone who cares passionately about his home state, it has been pretty exciting to be able to see our state moving towards something that I think will benefit every Idahoan, and I think that’s been extraordinarily rewarding,” Nelson says. “It has been amazing to hear stories from people who have been caught in the Medicaid gap and who have felt helpless realize that Medicaid expansion is the way out of that. One woman told me the story of her sister. She was diagnosed with cancer in the fall of 2015 and within weeks she died. Because Idaho hadn’t expanded Medicaid, her family had no idea how she was going to afford end-of-life care. Imagine trying to grieve over your sister, but instead you’re worrying whether your family can pay for treatment. That’s not a situation anyone should have to be in.”

Should Idaho expand Medicaid, approximately 62,000 more Idahoans will have insurance, which Nelson says is “A great number off the bat, but this [initiative] provides risk protection that everyone in the state can enjoy. Everybody in Idaho who faces the risk of losing their job benefits from knowing that should that happen, they don’t have to worry about where they’re going to get their health insurance. Currently, that’s just not the case – people have to worry that they’re going to fall into the gap.”

While expansion’s impact could be great, there is a long journey ahead, as a November vote is not necessarily the end of the line for this initiative. Maine’s governor, Paul LePage, has vetoed Medicaid expansion legislation six times and has refused to acknowledge the public referendum vote of 2017, despite a federal court order. However, Nelson is optimistic that the same thing will not happen in Idaho. Current governor Butch Otter is not running for re-election and both of the leading candidates have announced that they will uphold November’s vote, regardless of whether or not they support expansion.

Even if the initiative passes and the new governor stays out of the way, the legislature could still intervene. “Come January, when the legislature is back in session, it’s possible that they could overrule the Medicaid expansion, could tamper with the law in whatever way they see fit, or add on additional requirements,” Nelson explains. “If we are able to show sufficient support for Medicaid expansion at the ballot box, it will be a huge political risk for the legislature to oppose it strongly.”

Although polls show that 61% of the state is in support of the initiative, “there is still a lot of feeling in the state that people would rather not have the government involved in health care,” Nelson explained. Additionally, the legislature is arguably more conservative than the population, given the rules around the primary and who turns out to vote. Regardless, the campaign remains optimistic.

Whatever happens, it is clear that the ballot initiative process has allowed Idahoans to share their health coverage stories. Voters in Nebraska and Utah will have the same choice about Medicaid expansion in November. Expansion in these three conservative states would provide a fascinating counter-narrative to Republican efforts to repeal and replace the Affordable Care Act. It could also serve as a tipping point in the remaining 14 states that have not expanded Mediciaid and help the nearly two million people gain health insurance.

Quotes have been lightly edited for brevity and clarity.

Photo by Luke Mayville.