Shawn Vestal: Idaho lawmakers inexplicably keep demanding Medicaid work requirements

March 29-- Mar. 29--The Health and Welfare Committee of the Idaho Senate was meeting Wednesday to hear testimony about a proposal to hang work requirements on some of the people who will be newly covered under Medicaid expansion.

Fifty people had signed up to testify. All but one -- a representative of the deeply anti-Medicaid-expansion Idaho Freedom Foundation -- were there to oppose work requirements. Such requirements, critics argue, are both inefficient and punitive, and undermine the basic goal of the program: to provide health insurance for people who cannot afford it.

But work requirements are popular among those who see our current health care crisis chiefly as a mooching calamity -- the prospect of too many people getting too much help they don't deserve. Eight states have received waivers from the Trump administration to impose requirements that some recipients regularly prove they are working or volunteering. Proponents talk about helping people avoid "dependency," and the requirements are unambiguously aimed at driving people off Medicaid.

So, even though Idaho citizens voted by initiative to expand Medicaid after years of legislative resistance, legislative resistance has not gone away.

One form of it came in a proposal to hamstring the initiative process -- an idea opposed by four former attorneys general that is still creeping through the process. Another form of resistance came with a bill that would require Medicaid recipients between 100 percent and 138 percent of the poverty level to work 20 hours a week.

That bill, House Bill 277, was on the agenda at Wednesday's committee hearing. The measure was believed to have been put together in a way that would get it through both chambers of the sausage house and signed by Gov. Brad Little.

And then: deus ex machina.

Deus ex machina -- "god from the machine" -- is the term in stage drama for a sudden, unexpected, improbable resolution to a problem.

In this case, it was news of two court rulings that fell from the sky. Even as testimony proceeded, a federal judge threw out work requirements programs in Kentucky and Arkansas. Among the reasons: The states had failed to consider the "coverage-loss consequences" to a program that is, after all, meant primarily to provide health coverage.

Not long after, the Idaho committee voted to hold the bill, effectively killing it.

That doesn't mean some form of work requirement might not rise again in Idaho, or some other judge up the ladder might not change the legal landscape. Work requirements are an idea with a devoted following. They're also a bad idea -- bad for the people who the program is trying to help, and bad for the rest of Idaho taxpayers.

Idaho's proposed work requirements, for example, would have created a system that covers far fewer people at a far greater cost, according to one fiscal analysis.

HB 277 would cost Idaho almost four times more -- four times! -- than simply expanding Medicaid under federal program guidelines, according to the nonprofit Idaho Center for Fiscal Policy.

And yet, the same folks who have argued to reject Medicaid expansion because of its potential costs to the state have lined up behind it.

The added costs would come from all the places that small-government conservatives say they oppose -- more bureaucrats, more bureaucracy -- as well as much higher costs for the state that come with seeking waivers from the federal program rules.

The center's analysis found that expanding the Medicaid program without any extra conditions would cost Idaho $9.9 million. (The federal government pays 90 percent of the cost for states that don't monkey-wrench the program.)

HB 277 would leave the state with an annual cost of $42 million. The center's analysis differed from a legislative analysis that found a smaller increase, in part because they included the lower federal contribution that would come along with getting a waiver from the regular rules.

It also concluded that 10,000 people would lose health coverage, and 32,000 Idahoans who live just above the poverty line would be blocked from coverage though they qualify under federal rules.

That should have been enough to kill HB 277. Instead, it marched onward until Wednesday's rulings fell from the sky.

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