The fate of Idaho Medicaid expansion comes down to 2 words: work requirements

March 23-- Mar. 23--The Idaho Legislature is weighing two very different bills on how to expand Medicaid to Idaho's working poor.

Republican leaders say the big question they're grappling with is this: Should Idahoans seeking Medicaid coverage be offered work training? Or should they have to report their job status in order to get taxpayer-funded health insurance?

Idaho residents in November voted to give Medicaid to people with incomes up to 138 percent of the federal poverty level -- tens of thousands of adults who currently have no access to affordable health insurance. Passing with 61 percent of the vote, Medicaid expansion became law.

But it needs to be funded, and Gov. Brad Little said he won't let them rest until they've funded it. House Republicans are waiting to release those funds while the Legislature molds Medicaid expansion into the law it wants.

Idaho House passes work requirement

The House on Thursday approved a bill, sponsored by Nampa Republican John Vander Woude, with a number of add-ons to Medicaid expansion, including a "work requirement."

Work requirements are popular among conservatives, who say theykeep people from relying on government assistance unnecessarily. The House bill would require adults on Medicaid to work, train or volunteer at least 20 hours a week. Some Idahoans, such as parents and college students, would be exempt.

The bill is unlikely to have a big effect on the size of Idaho's workforce, though. Most adults on income-based Medicaid already work or belong to groups, such as people with disabilities, that can't work, according to research by the Kaiser Family Foundation, a nonpartisan health care think tank.

Meanwhile, a Senate committee narrowly passed its own bill by a 5-4 vote. That bill would include a voluntary work-training program like the one Montana attached to its Medicaid expansion.

Legislators heard testimony this week on both measures. Health care industry groups, people in the Medicaid gap, Proposition 2 supporters and health care providers made up most of the speaking roster. They opposed the House version and gave at least lukewarm support to the Senate version.

The House voted 45 to 25 to approve Vander Woude's legislation. Almost half of the "no" votes came from Republicans, such as Fred Wood, the chairman of the House Health and Welfare Committee and a retired doctor from Burley.

Wood spoke at length during House debate. Among other complaints, he said the bill creates a double standard: Idaho legislators who have the state employee health insurance plan don't have to report their work hours to anyone.

"We knew that it was not universally supported," House Speaker Scott Bedke of Oakley told the Statesman on Friday. "But 45 votes is a very strong showing."

Hill: Work requirement is 'the rub'

Senate President Pro Tempore Brent Hill, R-Rexburg, said he expects the House version to be the starting point for the eventual law.

The Senate version was viewed by many lawmakers as a backup, he said, in case a House bill failed to launch.

"We'll see what, if anything, the Senate demands be changed before [lawmakers] can support it on this side," he said in an interview Friday morning.

And the work requirement seems to be the "most controversial" part of that proposal, he said. Bedke agreed.

"If we can resolve the work issue -- whether it should be voluntary or mandatory -- I think that's where the rub is," he said.

Bedke added that "mandatory" could take different forms. "There are gradations of mandatory," he said.

Work requirements have been controversial politically and have caused problems in other states -- especially in Arkansas, where people have reportedly lost Medicaid coverage due to bureaucratic and technical troubles.

Vander Woude said during debate on his bill that he's aware of the problems Arkansas had and wants to avoid them in Idaho. His goal, he said, is to help people get into the workforce if they're not already there; not to deprive them of health care.

Work requirements also have prompted lawsuits in at least three states.

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