The Idaho state legislature is on the verge of enacting an unconstitutional bill nullifying the Affordable Care Act. Yet, while Idaho’s proposed act of nullification would have no impact whatsoever on the ACA itself, the Idaho Attorney General’s office warns that it could lead to a serious unintended consequence for the people of Idaho:
An additional legal ramification that must be considered as RS 20315 is contemplated is its effect on existing and future Idaho participation in the Medicaid Program. As a purely voluntary program, Idaho’s refusal to comply with the expanded provisions within the PPACA could potentially result in Idaho exiting the program and losing the existent federal matching funds. This could create a situation where individuals presently covered would no longer be covered, yet still require medical treatment, which likely would be required to be provided for and paid for through some non-federal means. This situation, in turn, could create an intense burden on the State’s
Medicaid is an entirely voluntary program in which the federal government provides generous grants to the states on the condition that the states comply with certain conditions. Yet, by attempting to nullify the ACA, Idaho would be refusing to comply with the voluntary conditions on its Medicaid funding spelled out in the ACA itself. Accordingly, nullification could have the effect of withdrawing Idaho from the Medicaid program altogether.
Were the state to do so, it would have drastic consequences for Idahoans and for their state’s budget. Presently, Idaho receives over $1 billion in federal grants to administer its Medicaid program — an amount that equals approximately two fifths of the state’s overall budget. If the state gave up this money, it would have to chose between eliminating health coverage for the 223,198 Idahoans who currently depend on Medicaid, or implementing similarly draconian cuts such as slashing its public schools budget by 85 percent.
ThinkProgress previously reported that the leading proponents of Idaho’s nullification bill — including Idaho Gov. Butch Otter (R) — decided to move forward with this ill-considered proposal after reading a book on nullification by leading Confederate apologist Tom Woods. As it turns out, there are very real consequences when state officials abandon the advice of real legal experts in favor of crackpot pseudo-historians like Woods. One of those consequences could be the end of Medicaid in Idaho.