Medicaid expansion ‘protections’ bill moves forward despite ‘no’ vote from Heider

Feb. 12--BOISE -- A bill that would attach certain conditions to Medicaid expansion in Idaho will receive a formal hearing in the Senate Health and Welfare Committee despite "no" votes from a Twin Falls lawmaker and three other committee members.

Sen. Lee Heider, a Republican from Twin Falls who previously chaired the Health & Welfare Committee, told the Times-News he believes the Legislature will need to develop "some rules and some standards" for implementing the Medicaid expansion ballot initiative that passed in November with 61 percent of the vote.

"Without the framework or the rules to hang things on, there's nowhere to put the money," Heider said.

But he didn't support legislation introduced Monday by Sen. Mary Souza, a Republican from Coeur d'Alene. Souza's bill will be printed and receive a formal hearing in the committee following a 5-4 vote.

The bill would authorize an optional workforce development training program for the expansion population, let Idaho apply for a federal waiver to help fund mental health treatment costs that are currently covered by counties, and allow the state to apply for a federal waiver for Idahoans over 100 percent of the federal poverty level to have subsidized insurance policies on the state's exchange. (The ballot initiative expanded Medicaid eligibility to anyone earning less than 133 percent of the federal poverty level.)

The legislation also contains two clauses: one requiring a review of Medicaid expansion by the Legislature during the 2023 session, and another that would void Medicaid expansion if the federal funding ratio changes and the Legislature does not take action to continue the program. Under the current federal funding ratio, the federal government pays for 90 percent of expansion costs and states cover the remaining 10 percent.

"These are protections and enhancements," Souza said in the committee meeting. "These are protections for the taxpayers of the state. You could say they're protections for the education budget or transportation budget or all those things we hear."

Of the votes against printing the bill, two came from the only Democrats on the committee, Sen. Maryanne Jordan of Boise and Sen. David Nelson of Moscow. The other vote came from committee chairman Sen. Fred Martin, a Republican from Boise.Souza, Sen. Abby Lee of Fruitland, Sen. Mark Harris of Soda Springs, Sen. Van Burtenshaw of Terreton, and Sen. Regina Bayer of Meridian -- all Republicans -- voted in favor of printing the bill.

Martin, Jordan, and Nelson all said they would like to see the Legislature implement Medicaid expansion without the additional conditions that the bill would attach.

"My preference has always been simply to fund it," Martin said. "I feel very strongly about trying to abide by the will of my constituents."

Jordan similarly said she had "grave concerns" about Souza's bill.

"We have all heard over and over from voters in the state of Idaho about their thoughts on Medicaid expansion," Jordan said. "I think this is very much in opposition to what the voters have asked us to do."

Heider had different concerns. He did not comment on the proposal during the committee meeting and did not elaborate in an interview with the Times-News after the vote on whether there were specific aspects of the bill he disagreed with. Instead, he emphasized the need for a more comprehensive "framework" for Medicaid expansion. "Ninety percent" of the emails Heider receives each day urge him and his fellow Legislators to fully fund Medicaid expansion -- "what the people wanted" -- without additional conditions, restrictions, or limitations, Heider said. But he said he doesn't believe that's possible.

"What the people wanted wasn't any kind of framework to hang money on," Heider said. "I just think we need a more thorough, comprehensive plan.

"I think we're going to get there during this session. I think we're going to have to get there during this session."

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