Idaho House introduces Medicaid expansion repeal bill - East Idaho News
Idaho

Idaho House introduces Medicaid expansion repeal bill

  Published at  | Updated at
Getting your Trinity Audio player ready ...

BOISE (Idaho Capital Sun) — Idaho Republican lawmakers on Friday introduced a bill to repeal a voter-passed law to expand Medicaid. 

Idaho House Health and Welfare Committee Chairman John Vander Woude, R-Nampa, presented the bill — House Bill 58 — which lists Idaho House Assistant Majority Leader Josh Tanner, R-Eagle, as a sponsor. 

“We’re on a trajectory that I just don’t think we can afford to continue,” Vander Woude told the committee. “And I do think we need to take a closer look.”

Introducing the bill tees it up for a full committee hearing, including public testimony and a possible vote to advance it to the Idaho House floor.

The Idaho House Health and Welfare Committee on Friday approved introducing the bill on a party-line voice vote. The 15-member committee’s only two Democrats — Idaho House Minority Leader Ilana Rubel and Rep. Megan Egbert, both from Boise — voted against introducing the bill. 

Rubel said she votes to introduce 99% of bills — even if she intends to oppose them — but not all. 

“This one, I just feel, would be so hurtful to so many people — and is so at odds with the clearly expressed wishes of the people of Idaho,” she said. 

What is Medicaid expansion? 

In 2018, after years of stalled legislative efforts to address the Medicaid gap, nearly 61% of Idaho voters approved a ballot initiative to expand Medicaid. The law took effect in 2020. The new bill would repeal that law

Since Idaho voters approved the law, support for expansion has risen, according to a 2023 poll by Boise-based public opinion research firm GS Strategy.

But many Republican lawmakers say expansion is a key driver behind Idaho Medicaid’s rising budget, which many say needs to be controlled. 

In recent years, several Idaho bills that could’ve repealed Medicaid expansion haven’t passed.

Some lawmakers say this year could pave a path forward for bills that either repeal or reform Medicaid expansion — pointing to significant turnover in the Idaho House Health and Welfare Committee, and Republicans securing control of the White House, both chambers of the U.S. Congress and the expanded supermajority control of the Idaho Legislature, the Idaho Capital Sun previously reported.

Some health policy advocates say a closer look at the state budget shows Medicaid has actually had steady budget growth, and that Idaho’s expansion has saved state spending in other areas and has saved lives.

About 90,000 Idahoans were enrolled in Medicaid expansion in December, the Idaho Press reported. 

Bill claims repealing Medicaid expansion would save Idaho $110M. Some lawmakers are skeptical. 

The bill’s fiscal notes estimates it would save the state at least $110 million annually. But some lawmakers said they were skeptical that figure was accurate. 

Rep. Lori McCann, R-Lewiston, said she wasn’t sure if she could support fully repealing Medicaid expansion. And she was skeptical the bill’s state savings estimate was accurate.

“We have a lot of indigent funds in our counties … the counties and the hospitals in my district. This, this would be very damaging, and I have a lot of rural areas. And so I have a concern, and I’d like to see an entire economic outlook of what this would do,” McCann said.

But she voted to introduce the bill, saying lawmakers should have a full hearing to closely evaluate the bill and possibly explore other sideboards that may help. 

Adding sideboards — which are essentially extra program rules like work requirements — is another way lawmakers have suggested to tamp Medicaid’s costs.

In a news release, the Idaho Joint Democratic Caucus said repealing Idaho Medicaid expansion would cost taxpayers much more than keeping it — by losing $1 billion in federal funds and undoing $80 million in savings across Idaho government. 

In 2023, Idaho’s Medicaid director told lawmakers Idahoans would spend almost $78 million more, by losing federal funding, if Medicaid expansion was repealed, the Sun previously reported. 

“This is a drastic proposal to undo the will of the voters who voted to expand Medicaid and to take health care away from 85,000 Idahoans in families that get by paycheck-to-paycheck,” Hillarie Hagen, senior policy associate at Idaho Voices for Children, said in a statement. “… Pushing Idahoans back into the coverage gap would cause our uninsured rates to skyrocket, with rural Idaho facing the greatest harm.”

Before Idaho voters passed Medicaid expansion, Republican lawmakers worried feds would reduce extra pay. 

Under the Affordable Care Act passed in 2010, the federal government incentivized states to expand Medicaid to a broader range of low-income earners by offering to cover Medicaid expansion policies at a higher federal matching rate of 90%.

Idaho was one of several holdout states that didn’t expand Medicaid. 

But in not expanding Medicaid, tens of thousands of Idahoans were left in a medical insurance assistance coverage gap, dubbed the Medicaid gap. People in the gap earned too much to qualify for Medicaid, but too little to qualify for tax subsidies on Idaho’s health insurance marketplace, Your Health Idaho.

Republican state lawmakers have long worried states would be left to pay higher costs for expansion if the federal government reduced its extra pay.

Vander Woude’s biggest fear, he said, is that the federal government might halt its higher match rate when looking at the federal government’s deficit. The federal government may reduce that down to the typical match rate of about 70%, he said, which would leave Idaho to pay another $200 million.

Bill doesn’t include call to reestablish indigent health assistance programs

Rubel, the House Democratic leader, pointed out that the bill doesn’t call for Idaho to restore state and local government indigent health care assistance programs.

State lawmakers ended those programs after voter-approved Medicaid expansion took effect.

Through those programs that helped people who couldn’t afford high medical costs — called the Catastrophic Health Care Fund, or CAT Fund, at the state level and the indigent health care fund in counties — Idaho “expended significant monies to ensure that hospitals didn’t eat all those costs,” Rubel said.

“I think this fiscal note is entirely inaccurate,” Rubel said. “Everything that I’ve seen indicates that it would actually cost the state more to get rid of Medicaid expansion than it would save. … There have been huge savings throughout the system — in corrections and behavioral health, certainly in terms of all those funds we had to stand up before to ensure we don’t lose all the rural hospitals.”

Vander Woude said lawmakers could consider some of those options if the bill advanced. But he said he “wasn’t crazy about the CAT fund when we had it, and I’m still not crazy about it now.”

“I believe that we may have to develop some programs later that will encourage some costs if this moves forward,” Vander Woude said.

The Idaho Legislature’s budget-setting committee, the Joint Finance-Appropriations Committee, is scheduled on Feb. 26 to set the budget for the Division of Medicaid in the Idaho Department of Health and Welfare, according to a new committee schedule released early Friday.

SUBMIT A CORRECTION