As President Donald Trump and Congress prepare for round two in the debate over how, or even if, Americans have a right to health care, the fate of some of Idaho's most vulnerable men, women and children hangs in the balance.
"No, I do not believe that health care is a human right," Rep. Raul Labrador (R-Idaho) said at a Meridian town hall meeting April 19.
Labrador's comments exploded across social media and were retweeted across the U.S. "GOP Rep. booed at town hall for saying healthcare isn't a 'basic human right,'" wrote The Hill.
At another town hall in Enon, Ohio, Rep. Warren Davidson (R-Ohio) had his own social media moment when he told a mother whose son depends on Medicaid, "I don't believe that the taxpayers are entitled to give that to him."
Davidson, whose March 9 bill to introduce a "means-tested welfare program" was co-sponsored by Labrador, elicited his own set of boos when he added that the son should "go earn those benefits" by getting a better job.
"I have to watch my blood pressure when I hear such things from Labrador or anyone else," said Judy Austin. "Health care is a human right."
Austin has personal experience with health care in general and Medicaid in particular. Her 33-year-old stepson Ian Bott's diagnosis puts him on the Autism spectrum, requiring much-needed help from Medicaid.
"Medicaid helps me with my treatment, and it helps to allow me to live on my own now; I have a studio apartment in Boise. It helps me with my transportation to my job at Albertsons and my school at Boise State."
According to the Idaho Department of Health and Welfare, about 270,000 Gem State residents access Medicaid benefits—the overwhelming majority (approximately 208,000) being children. Tens of thousands of adult men and women challenged by disabilities depend on Medicaid for health services, skilled nursing, independent living assistance and transportation.
Understanding Bott's concern first requires a grasp of the proposals put forward by the Trump White House and multiple GOP sponsors.
In their effort to repeal and replace Obamacare, they propose a massive restructuring of Medicaid. At the heart of those proposed changes is shifting Medicaid to a so-called "block grant" or per capita funding mechanism. In effect, they would dismantle the current spending blocks and limit each state's share. That would leave it up to individual states to determine whether the resulting funding shortfall should be supplemented by increasing revenues (higher taxes) or cutting services. Even a novice Idaho Statehouse watcher would conclude that the Legislature isn't inclined to increase taxes to supplement Medicaid any further. The recently completed session of the Legislature approved a Fiscal Year 2017 Medicaid budget that was $6.2 million lower than even Governor C.L. "Butch" Otter had proposed.
"If Congress decides to cap Medicaid going forward and shifts more of the burden to states, services will be at risk," said Mike Skelton, board president of the Consortium for Idahoans with Disabilities. "And Idahoans with disabilities would take the brunt of those funding cuts."
It's a myth that Medicaid is bloated with fat. For evidence, look no further than the Idaho Legislative Services Office, which in its budget book for FY 2017 wrote that for every $1 invested in Idaho's Medicaid program, 97 cents is spent directly on health services for Medicaid beneficiaries. Only 3 cents pays for administrative costs.
"Medicaid does something that no other medical insurance program does: provide long-term support and services for people with disabilities," said Jim Baugh, executive director of DisAbility Rights Idaho. "These services are simply not available through private insurance and they're too costly for people to afford out of pocket—especially given the low incomes of most people with disabilities."
That was the scenario shortly after Bott was diagnosed on the autism spectrum.
"When I was a boy, my mom had to work multiple jobs but we got by," Bott said. "That's why my Medicaid was so important. It has to be there not just for me, but for our parents."
Close the Gap Idaho, a coalition of advocates for Medicaid families, warns that the shift to block grant funding folded into Republican proposals to repeal and replace Obamacare "will likely lead to cuts of Medicaid services ... such as home and community-based services."
Those were the exact services Bott required to get him to where he is today.
"I have my own apartment not far from here," Bott said, standing near the Idaho Statehouse.
Without the services Bott received as a boy—and continues to receive as a young adult who holds down a job and goes to college—his life could have taken a very different path, ultimately costing taxpayers much more.
"Cuts to these cost-effective and successful services may force people out of their homes and communities and into more expensive institutions," Close the Gap Idaho wrote in a statement.
Whatever happens with GOP efforts to change Medicaid, Bott has big dreams.
"Do you know what I'm going to do when I graduate from Boise State? I'm going to start my own nonprofit," he said. "I want to help make it possible for more care for parents of people with disabilities. They shouldn't always have to worry every second of the day about their kids. Maybe we should all care about their kids a little more. Then they can grow up and be successful—like me."