Idaho’s Medicaid expansion may help businesses.  According to the Idaho Association of Commerce and Industry, a decision not to broaden Medicaid’s reach would cost between  $12.3 million to $18.5 million a year in penalties for large companies that don’t insure their employees and unspecified amounts for other businesses as their insurance and taxes continue to subsidize care for the uninsured.

The Affordable Care Act required states to expand their Medicaid programs, though last year’s Supreme Court decision made that expansion optional.  At any point Idaho can decide to offer Medicaid to its poorest adults, but lawmakers have made no moves toward expanding the program by next year.  Under the expansion, a single person working 30 hours a week at minimum wage or less, would qualify for Medicaid coverage.

Idaho has the largest portion of minimum-wage workers in the nation, with about 1 in 13 employees earning minimum wage ($7.25 hourly) or less.  Many can’t afford health insurance and starting in 2015, employers may face the choice between offering them insurance or paying a large fine.  Businesses with 50 or more full-time equivalent employees must offer health insurance benefits starting in 2015 or be subject to federal tax penalties.

If their employees qualify for Medicaid, the businesses wouldn’t have to provide health benefits and would avoid the fines.  Idaho’s decision on Medicaid expansion could provide a multimillion-dollar savings for the state’s businesses since many full-time employees would qualify.   Right now, there are few who qualify, leaving them uninsured and their employers facing huge fines in the future. 

According to U.S. Census Bureau data from 2009, about 91,000 Idaho residents between ages 18 and 64 had incomes low enough to qualify Medicaid under an expanded system.   Nearly half of them were without any insurance coverage.

The Medicaid program would gain thousands of patients, many with untreated chronic illnesses. Federal taxpayers would pay 100 percent of the cost for the first few years, then shift slowly to the state, with the state required to pick up 10 percent starting in 2020.  If Idaho based businesses don’t offer low-premium plans to workers, they may be fined thousands of dollars for each employee who buys a subsidized health plan to comply with the rule that all Americans be insured—a substantial cost that could force many businesses to close their doors.