As Idaho Gov. Brad Little prepared his budget proposal before the State of the State address, his office saw an anticipated but still-notable balancing act between two statistics:

• A $40 million requirement to bridge Medicaid expansion in Idaho, and

• A 15 percent drop in enrollment through the state’s health care exchange, YourHealthIdaho.org.

The two numbers are inextricably linked. As Idaho folded into Medicaid’s most recent expansion to reach households within 138 percent of the poverty line, fewer Idahoans found the need to enroll in the state’s Affordable Care Act-driven exchange.

Prior to expansion, a one-child single parent in Idaho didn’t qualify for Medicaid if he or she made more than $3,468 per year. The expansion now covers single Idahoans making up to $17,236, or $35,535 for a family of four.

Leaders from Kootenai Health in Coeur d’Alene say a covered patient is a more empowered patient.

“When patients feel confident seeking needed health care, it helps improve their outcomes,” Kim Anderson, communications director for Kootenai Health, told The Press. “Having more people with the medical coverage needed to help cover the cost of annual wellness visits, preventive care, and care for health issues as soon as they arise will help improve the overall health of our community.”

Anderson added that the community hospital is interested to see how the new coverage models will impact the sheer number of visits Kootenai Health receives each year, as a decrease in emergency room visits might not occur — as expected or promised by Medicaid and ObamaCare proponents — because of swelling growth in North Idaho.

“It is hard to speculate what the impact will be to the number of patients seeking care at the emergency department,” she said. “We do know that when patients have access to the care they need from their primary care physician or provider, they are less likely to use the emergency department for conditions that are not true emergencies. As our local population continues to grow, patient visits to our emergency department continue to grow as well. That makes it even more important to ensure all patients are receiving care in the most appropriate setting.”

Idaho voted to approve Medicaid expansion in 2018 with a 61 percent vote of approval. Before Nov. 1, only 11,000 state residents were on the rolls. Since Nov. 1, about 52,000 have signed up. Health and Welfare officials estimate as many as 91,000 Idahoans — or 5 percent of the state’s population — could qualify.

While Medicaid expansion is a largely funded mandate that will cost the federal government approximately $360 million, Little’s budget proposal ponies up the state’s $40 million share, though $8.5 million of that allotment is divided between the counties.

Meanwhile, approximately 89,000 Idahoans who do not qualify for Medicaid have enrolled for health insurance through YourHealthIdaho.org. The exchange reports approximately three-quarters of those enrollees are existing customers who renewed, while the other quarter of that figure represents new customers. What’s noteworthy is the larger figure itself: The 89,000 is about 14,000 lower than enrollment numbers from this time last year.

“We always knew Medicaid expansion was a possibility, and that as a result, enrollments on the exchange would be impacted,” Your Health Idaho executive director Pat Kelly said. “We’ve planned for this change and do not expect to see any material adjustments to our long-term sustainability.”

Kelly added that a tax advantage could show an added economic benefit to the households that enrolled under the program.

“What we are most excited about at Your Health Idaho is the number of Idahoans who are new to the exchange,” Kelly said. “Many of these individuals and families now have comprehensive health insurance for this first time, and most are eligible for a tax credit and lower monthly premiums with Your Health Idaho.”

Approximately 11 percent of Idaho residents are uninsured, according to a report from the Aspen Institute. That same report said 15 percent of the state’s population has medical bills in collection, with a median medical debt among that percentage of $807.

Anderson emphasized, however, that debt would never factor into Kootenai Health’s quality of care.

“Kootenai Health provides care to all patients regardless of their ability to pay,” she said. “That being said, when patients understand their health coverage benefits, they can make more informed choices about the type of care they choose.”