Lawmakers set the stage for battle over Idaho’s Medicaid expansion

A panel of Idaho lawmakers wants the Legislature to repeal the state’s voter-enacted Medicaid expansion, which provides health care coverage to about 90,000 lower-income Idaho residents.

Members of the Legislature’s interim “DOGE” committee voted Friday to recommend repealing the state and federal subsidies to Idahoans who earn too much to qualify for standard Medicaid but not enough for private insurance discounts under the Affordable Care Act, or Obamacare.

The DOGE Task Force said a repeal was necessary to cut costs amid the state’s growing budget deficit. The task force is modeled after Elon Musk’s so-called Department of Government Efficiency that worked to slash the federal bureaucracy and cut costs after Donald Trump returned to the presidency in January.

Lawmakers shared anecdotes suggesting that people were taking advantage of the system, avoiding working full-time jobs so that they wouldn’t lose their Medicaid benefits.

“The more I’ve dug into budget issues, into social issues on this, it becomes a more blaring light to me of what is actually going on within this program,” Rep. Josh Tanner, R-Eagle, told fellow DOGE committee members. The Medicaid expansion population is “becoming a large burden upon the state,” he said.

The vote was only a recommendation, but it set the stage for another year of debate over the program’s repeal.

That discussion dominated the 2025 legislative session. Initial bills proposed slashing the program’s funding or cutting it entirely, before lawmakers settled on House Bill 345, a compromise that will implement a network of medical providers that operate on a fixed budget to reduce costs and will require Medicaid expansion recipients to report their hours worked. Lawmakers in recent months have worked to come up with a plan for the transition to this “managed care” model, which may take years.

Medicaid Expansion passed in 2018 as a ballot initiative with over 60% support from Idaho residents. When he signed House Bill 345 into law in March, Gov. Brad Little called it a “huge improvement” over previous suggestions to repeal the program entirely.

“I am pleased House Bill 345 improves the Medicaid program without rejecting the will of the voters on Medicaid expansion,” he said at the time.

Little had previously expressed reservations about cuts to the Medicaid expansion program. The two-term Republican governor said he was “all about cost control,” but also said it was important to remember that Medicaid expansion “was passed overwhelmingly by the public” through the ballot initiative process just over six years ago, the Idaho Statesman previously reported.

The federal government pays 90% of the costs of Idaho’s Medicaid expansion, which as of early 2025 provided access to care for about 90,000 Idaho residents. But amid rising health care costs, Idaho’s share of the burden has significantly exceeded lawmakers’ expectations: from $32 million in projected costs in 2018 to $110 million in fiscal year 2026, said Rep. John Vander Woude, R-Nampa, on the House floor in February.

Idaho Democrats condemned Friday’s vote, pushing back on the idea that repealing Medicaid Expansion would save the state money.

“The myth that repealing Medicaid Expansion would save money is just not true. When you take coverage away, people don’t stop getting sick. They wait until it’s an emergency,” said Senate Minority Leader Melissa Wintrow, D-Boise, in a statement. “Then the bill lands on rural hospitals, county budgets, small businesses, and taxpayers.”

Friday’s meeting was the committee’s last. Republican legislative leaders created the committee in April, inspired by an unsuccessful bill with the same aim during the 2025 legislative session. The committee has seven Republicans and one Democrat and is evenly split between representatives and senators.

All members except Sen. Carrie Semmelroth, D-Boise, and Rep. Dustin Manwaring, R-Pocatello, voted in support of repeal.

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