Idaho Republicans retreat from Medicaid expansion plan this session

March 23--Idaho House Republicans fell back Wednesday from taking a significant step toward addressing the health care needs of 78,000 poor Idahoans, instead pushing forward two incremental measures that critics labeled "woefully inadequate" and a needless delay.

The move came as the Legislature rushes to complete its work for the year and adjourn, and days after the House appeared ready to embrace much more decisive action on health care for the poor, support for which collapsed over the weekend. Two bills introduced in the morning were passed by the House in the afternoon and sent to the Senate. A Senate hearing is scheduled for Thursday morning.

"This is a small step," Rep. John Vander Woude, R-Nampa, the House GOP caucus leader, said during a charged House floor debate. "This isn't intended to cover the whole gap and provide them with all their needs. But this is a step in the direction that I think we need to go."

The Legislature now is eyeing a Friday adjournment, with action still expected on issues including urban renewal, a few appropriations bills, and a House tax cut bill that was scheduled for a vote Wednesday, but tabled.

Wednesday morning, the House Health & Welfare committee sent to the House floor one bill to create a legislative committee to study the needs of the so-called "gap" population -- those whose incomes are too high to make them eligible for current Medicaid and too low to allow them to apply for subsidized health insurance on the state exchange.

A second bill provides $5.4 million to help the current health care system collect more data on that population and provide nominal additional support for health services.

The move for more study comes after two governor-appointed task forces, in 2012 and 2014, recommended the state opt to expand Medicaid as provided under the 2010 Affordable Care Act, but via a federally-approved waiver that lets the state modify how the funding is applied.

Rep. Lynn Luker, R-Boise, presenting the measures on behalf of the Republican house leadership, said the legislature "has not had its own opportunity to sit down and review all of that."

Supporters on the committee acknowledged that the action was less than they wanted but the most they could achieve this session. Referring the matter to a legislative committee delays meaningful action on Idaho pursuing a federal waiver for a state-driven custom Medicaid expansion plan.

"I was hopeful that we would maybe make a little bit faster track, but at least we're still moving toward finding the right solution: a waiver here in Idaho that would allow for managed care," said Rep. Kelley Packer, R-McCammon.

Committee chairman Rep. Fred Wood, R-Burley, noted that conventional Medicaid expansion as set forth under Obamacare was "never going to go anywhere" in Idaho.

Under a proposal that surfaced last week, Idaho would have sought approval for a managed-care health program for the gap group using the state's fledgling performance-based, community-centered health care system that moves away from the fee-for-service model for patient care.

"We were only going to get to Medicaid expansion when we had a system where we could measure outcomes, we could control costs, etc.," Wood said. "The fact is, we do what we can do, and you can't get done what you can't get done."

The committee's two Democrats denounced what they described as another costly delay in addressing the needs of the gap population.

"We're wasting money and we're exposing Idahoans unnecessarily to premature death," said Rep. John Rusche, D-Lewiston. "Further delay with another study will not save lives, will not save money, and therefore I think it's the wrong decision."

Rep. Brandon Hixon, R-Caldwell, joined the Democrats in opposing the measures, calling them "not a viable solution" for the gap group or the state to contain health care costs.

Both bills passed the committee on an 8-3 vote, moving directly to the House for consideration without further public testimony. The afternoon House votes were closer, 40-29 on the interim committee and 43-26 on the funding.

Health-care system representatives and state health officials were sharply critical. Expansion would deliver new federal dollars to fund health care for the gap group and eliminate state and county expenses for medical bills when someone can't pay. Instead, the state is opting to pay a little more into a community-based health network that already gets federal funding, without eliminating other costs.

"Ideologically, they oppose using state dollars to attract federal dollars to this state under a Medicaid-expansion scenario, and yet today they subsidized federally funded health care centers with state dollars,"said Brian Whitlock, Idaho Hospitals Association president and CEO. "All they've done is make themselves a little bit pregnant on this issue, without addressing the real needs that exist."

He added: "The sad thing is there are a majority of members in the House of Representatives that actually wanted to do something substantive and meaningful this session, and rather than do that they are doing something that won't even make a dent."

Health and Welfare Department Director Richard Armstrong said the Legislature had acknowledged that people in the health care gap "are in desperate shape, that they are struggling," but that the action before the House "doesn't give me the authority to begin the waiver process with the federal government, so it pushes it out for at least another year."

The proposed funding is "woefully inadequate," he said. A plan unsuccessfully floated this session for $30 million in new state health care funding "was the minimum to give some kind of meaningful care to the whole population. Five million simply won't do that."

Bill Dentzer: 208-377-6438, @IDSBillD

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