In Idaho, folks who can't pay their medical bills and don't qualify for federal assistance have their cases routed to the Catastrophic Health Care Fund. The counties pick up the first $11,000 and the state pays the rest.

CAT Fund Chairman Roger Christensen's report to legislative budget writers last week laid out a good-news, bad-news scenario. The good news is the fund saved $9.5 million over the past 18 months. Even with those savings, Idaho's counties doled out $28 million last year and the state kicked in $27 million. The bad news is that mechanisms used to save that $9.5 million are going away. Also, the fund is seeing large increases in the number of participants, and costs are guaranteed to rise.

The best option Idaho has is to expand Medicaid coverage to an estimated 80,000 Idahoans. Beginning next year, the feds would pay 100 percent of the costs for three years and never less than 90 percent thereafter.

Gov. C.L. "Butch" Otter's working group on Medicaid expansion recommended extending coverage because it would save millions and provide better care for uninsured Idahoans. CAT Fund Administrator Cynthia York told legislative budget writers about one of those people last week.

This Idahoan was born with a chronic disease. Over the first 18 years of his life, he qualified for Medicaid and had access to preventive care. During his last three years on Medicaid - at ages 16, 17 and 18 - his medical bills totaled $68,904. The feds paid 70 percent, leaving Idaho's taxpayers on the hook for $20,000.

In January 2012, he turned 19 and no longer qualified for Medicaid. That meant an end to his preventive care. So, inevitably, he got sick. Emergency room visits and extended hospital stays added up to $280,000 for just six months. Those charges will be paid at the Medicaid rate, bringing the total down to $150,000. His home county will pay $11,000. The rest, $139,000, comes out of the state general fund.

This young man is representative of many with chronic illnesses. That's why Arizona Gov. Jan Brewer, like Otter an Obamacare opponent, thinks it's a good idea for her state to expand Medicaid coverage. Brewer and Republican governors in North Dakota, Nevada and New Mexico understand money can be saved preventing illness rather than treating it after it has occurred.

Otter, however, wants more time to contemplate the pros and cons. But this one's a slam dunk. York reports that expanding Medicaid would cover 90 percent of CAT Fund cases. Idaho has an opportunity to provide improved care for more of its citizens, including a sizeable number of working uninsured, while cutting property taxes and leaving more money in the state general fund.

The kicker: If Idaho doesn't expand Medicaid now, it forfeits the first of three years of 100 percent federal funding.

What are we waiting for?