Idaho residents on Medicaid, doctors bemoan GOP efforts to repeal citizen-led expansion

Boise resident Jennifer Johnson has two children and works two jobs — running a business for children with disabilities and as a part-time bookkeeper.

She also receives her health care coverage through Medicaid, a federal government-provided insurance for lower-income Americans. But because Johnson earns too much to qualify for standard Medicaid — yet not enough for private insurance discounts — she’s like 90,000 other Idahoans, according to the Idaho Department of Health and Welfare, who benefit from the state’s Medicaid expansion.

But if either of two active bills in the Idaho Legislature this year were to become law, she would lose her health insurance and be unable to afford private coverage, she told the Idaho Statesman. Johnson is one of tens of thousands of Idahoans caught in the “Medicaid coverage gap” following passage of the Affordable Care Act under the Obama administration.

Inaction from Idaho lawmakers left those low-income residents without any health insurance, and led voters in 2018 to pass a ballot initiative to implement Medicaid expansion. The program offers coverage to a larger number of those residents. Backed by then-Gov. Butch Otter, the citizen-led effort passed with more than 60% approval.

Since then, Republican lawmakers have spent years decrying the costs of Medicaid to the state. Now, through two bills, they seek to repeal or curtail the expansion program.

House Bill 138, sponsored by Rep. Jordan Redman, R-Coeur d’Alene, would repeal Medicaid expansion unless a set of 11 conditions are met — several of which would require federal approvals that have historically not been forthcoming. House Bill 58, sponsored by Rep. Josh Tanner, R-Eagle, would repeal Medicaid expansion outright.

Bill advanced despite 18-to-1 ratio of public opposition

Earlier this month, Johnson, 49, told the Statesman that she reviewed the state’s health insurance exchange this month to price plans available to her if she lost her Medicaid expansion coverage. The cheapest health care plan she found cost $786 a month — about 60% of her income — with an $18,400 deductible, she said.

“I would have to just go without coverage,” Johnson said, and likely wouldn’t be able to afford her children’s prescriptions. One has a developmental disability and the other has a congenital heart defect. “The whole point of why we passed Medicaid expansion is that gap.”

Others said they are in the same boat. John Barnes, 56, of Boise, told the Statesman that without his Medicaid expansion insurance, his medications would cost $2,500 a month — more than double his income on a doctor-restricted work schedule.

During a public hearing last week, Redman said his proposal would rein in Medicaid spending and prevent what he called “skyrocketing” costs from continuing to increase. He claimed his bill would keep the program alive: “This bill does not kill Medicaid expansion.”

But outside experts and some Republican lawmakers said meeting all 11 conditions required to maintain the program has little chance of happening. Those include limiting the number of participants to 50,000 enrollees, adding work requirements, capping program participation at three years and cutting down on improper payment rates.

More than half of them would likely require waivers from the Centers for Medicare and Medicaid Services to go into effect in Idaho.

“I know we want to say it’s not a repeal bill,” said Rep. Ben Fuhriman, R-Shelley. “But it (is), in essence — because I don’t believe we could get these waivers.”

At a public hearing last week, more than 300 people signed up to testify against the bill compared to just 17 signed up in favor — about an 18-to-1 ratio. After a nearly three-hour hearing, the House Health and Welfare Committee advanced Redman’s bill by a single vote, with five Republicans joining two Democrats in opposition.

Numerous doctors from around the state testified that Redman’s bill would harm their communities.

“If you repeal Medicaid expansion, it will create enormous costs for rural hospitals and local communities,” said Dr. Brandon Mickelsen, a family physician and program director at Idaho State University’s family medicine residency.

Others said that Medicaid expansion allowed local counties and the state to stop paying for catastrophic health care expenses for poor residents — programs that the bill does not contemplate reinstating.

Ending the program would eliminate much of the state’s health care safety net, said Christine Pisani, executive director of the Idaho Council on Developmental Disabilities. Doing so could cause Idaho to lose a large number of its low-paid, at-home care workers, who are now eligible for expansion, she warned.

“We cannot afford to lose any more workers in this field,” Pisani testified to the committee.

Dr. Darin Lee, an emergency room physician with the Saint Alphonsus Health System, told the Statesman in January that the loss of coverage would cause people to die. “The short answer is yes,” he said.

Research indicates that 240 additional Idahoans per year would die without the state’s Medicaid expansion, said House Minority Leader Ilana Rubel, D-Boise.

Rather than a “reform,” Idaho’s Democratic caucus said the bill “would end Medicaid coverage for those who desperately need it. It would cause thousands of jobs and over $1 billion of economic benefit to leave the state, shift enormous costs to Idaho taxpayers, and force the closure of rural hospitals.”

Fred Birnbaum, a lobbyist for the Idaho Freedom Foundation, said the conservative think tank supports the bill. He stressed that the federal money used to pay for Medicaid is largely borrowed, and that the nation’s mounting debt would soon lead to a financial crisis.

Chris Cargill, president of the Mountain States Policy Center, said too many people view Medicaid as “free federal money.”

“But remember, state taxpayers are federal taxpayers, too,” Cargill said.

FGA Action, an organization connected to the Foundation for Government Accountability, a conservative, Florida-based nonprofit, also testified in support.

In an analysis released this month, the Idaho Fiscal Policy Center determined that Medicaid expansion saved Idaho taxpayers $5 million and reduced the costs of caring for uninsured residents. An analysis by University of Idaho economics professor Steven Peterson estimated that each federal dollar spent on Medicaid results in $1.82 in economic activity in the state.

‘We’re real people’

Redman told House committee members this month that his bill is a “common-sense” proposal to “restore integrity, fiscal responsibility and self-sufficiency back into our Medicaid program.”

“If we don’t fix this, we’re going to be watching Medicaid drain our budget and put able-bodied adults ahead of those that truly need the help,” he said.

Barnes works 12 hours a week at Home Depot — the maximum recommended by his doctors because of ongoing health issues. He also attends the College of Western Idaho, where he’s made the honor roll while taking courses in painting, sketching and photography.

Barnes lives in and is a leader at a sober house in Boise. He told the Statesman that he has a stomach disease and a mental health condition that require regular treatment and specialized care.

Many of his current health problems, Barnes said, worsened when he went without treatments when he was younger, because he couldn’t afford coverage.

Medicaid expansion “opened the door for me to be able to see the doctors that I see now,” he said during an interview at a Boise coffee shop. Without them, “I don’t think I’d be sitting here right now.”

Johnson, the Boise mother of two, said that a lot of Idahoans work low-wage jobs that put health care on the open market out of reach.

“Providing health care for people to live is not a bad thing,” she said, noting that she runs her business for children with disabilities because she believes in its services, even though it doesn’t earn her much money. “I don’t think I’m whatever bum that people think are on Medicaid.”

If he were in the Legislature, Barnes said, he would work to provide health coverage to Idaho residents in need, not try to take it away.

“We’re real people, and a lot of us don’t have the ability or the means to pay for a lot of that stuff,” he said. ”The expansion is very helpful.

“I would love to make enough money to not even be on state funding. That’s my goal.”

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