‘We’ve seen this play out’: New bill to curtail Idaho’s Medicaid expansion moves forward

A House committee chamber at the Idaho State Capitol was so packed early Tuesday morning that the officer standing guard had to turn people away. Dozens had descended upon the hearing room to testify on yet another proposal to curtail spending on the state’s Medicaid expansion program.

The newest bill, sponsored by Jordan Redman, R-Coeur d’Alene, represented an effort to compromise on the proposal. It includes removing a “trigger” in a prior bill that would repeal the state’s Medicaid expansion if it couldn’t clear certain hurdles that critics had called virtually insurmountable.

The new bill also eliminates a cap on the number of people who can be enrolled in the program, and a limit on the number of months they can be enrolled over their lifetimes. A prior version sought to restrict it to three years.

But to make up the difference, Redman told committee members, he added new components to the bill, including “managed care,” which provides a network of medical providers and oversight of health care providers to reduce costs. He also added a requirement for Medicaid expansion recipients to report their hours worked.

Those additions drove much of the debate over the bill Tuesday, with lawmakers questioning whether the bill would add red tape, complexity and cost to the Medicaid expansion program. They expressed concerns that the work reporting requirement would be costly to administer, perhaps canceling out other savings the bill could offer.

“When Arkansas implemented their (work requirement), it cost them $26 million before the court said stop,” Rep. Ben Fuhriman, R-Shelley, told the committee. “When Georgia implemented theirs, they’ve already spent $80 million.”

Redman’s proposed work requirement is very similar to that of Arkansas, said Hillarie Hagen, a health policy associate at Idaho Voices for Children, in her testimony against the bill. And in Arkansas, she warned, one in four people subject to the work requirement lost Medicaid expansion coverage — even though 95% of those recipients actually met program requirements or qualified for an exemption.

“We’ve seen this play out,” Hagen said.

Proposals to slash Medicaid expansion spark conflict

After Redman’s initial proposal passed the House last month, the chair of the Senate’s Health and Welfare Committee quietly took action to stall the bill’s progress, urging Redman to sponsor a new version with compromises, the Idaho Capital Sun reported.

But last week, when the chair, Sen. Julie VanOrden, R-Pingree, was absent, some committee members sought to move Redman’s original bill onto the calendar for a hearing. (Committee chairs typically control their committee’s agendas.)

“This is passed in the House and Medicaid costs have more than tripled,” said Sen. Glenneda Zuiderveld, R-Twin Falls. “This bill should be heard by the committee. It is too important to be left in a drawer.”

Sen. Melissa Wintrow, D-Boise, who attended the meeting, told the Idaho Statesman that the committee’s vice chair, who’d been leading the meeting in VanOrden’s absence, was “blindsided” by the move.

The moment exemplified sharp tensions inside the Capitol — and around the state — over efforts to slash the Medicaid budget. The issue also has sparked public outcry, including at a volatile town hall in Coeur d’Alene that made national headlines.

The Affordable Care Act, passed in 2010, required states to expand Medicaid coverage to continue receiving federal funding. But the U.S. Supreme Court struck down that requirement in 2012, leaving it to individual states to decide whether to broaden the list of qualified recipients.

The Republican-dominated Idaho Legislature chose not to expand offerings to lower-income residents in the so-called coverage gap — those who earned too much to qualify for standard Medicaid but not enough for private insurance discounts. The number of Idahoans in this gap is about 90,000, according to the Idaho Department of Health and Welfare.

That led Idaho residents to bring forth a successful ballot measure in 2018, and Medicaid expansion has been in place in Idaho since then, the Statesman previously reported.

But the cost of the program is “not sustainable,” Rep. Wendy Horman, R-Idaho Falls, said on the House floor last month. Rep. John Vander Woude, R-Nampa, said in a January hearing that the state program’s expected costs went way beyond what lawmakers expected: from $32 million in projected costs in 2018 to $110 million in fiscal year 2026.

Redman has focused on a need to cut the state’s spending on the program’s “skyrocketing” costs, he said at a public hearing.

The federal government pays 90% of the costs of Idaho’s Medicaid expansion. But GOP lawmakers in the state raised concerns that the Trump administration might lower the payment threshold as it targets federal spending, and Idaho taxpayers could be left holding the bag.

“If the federal government reduced Medicaid expansion dollars tomorrow, would Idaho be ready?” asked Chris Cargill, president of the Mountain States Policy Center, during testimony Tuesday in favor of Redman’s latest proposal.

Rep. Lucas Cayler, R-Caldwell, pushed back on concerns that work reporting requirements were too burdensome. He argued that those residents benefiting from the program owed some “accountability” to the taxpayers funding their health care.

“With a taxpayer-funded program, we have people who are funding this — a lot of folks that are working multiple jobs, they’re barely making ends meet in a time of historic inflation,” Cayler told the committee. “Yet, a lot of these people are still being required to pay the tax to fund other people’s health care through the expansion” — even as they “pay out of their own pocket, in many cases, for their private health plans.”

In the same meeting, Michael Thomas, a social worker, argued in his testimony against what he called an “assumption” among some lawmakers that people relying on the Medicaid expansion “don’t want to work” and need the work requirements in Redman’s bill to “be forced to go to work.”

“My practice has shown that’s blatantly false,” he said. “Taking away health care coverage does not make people work. In fact, it creates more people that are ill and are unable to address their health care needs, which would allow them to get back to work.”

The committee voted to send Redman’s newest bill to the House floor for consideration.

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