Medicaid bill advances

BOISE — The House Health and Welfare Committee on Wednesday narrowly approved a bill placing strict conditions on Medicaid expansion, under the threat of full repeal, after around two hours of overwhelmingly negative testimony.

Members voted 8-7 to send House Bill 138 to the floor with a recommendation that it pass, with several who opposed it saying they were concerned about the bill’s “trigger” of a full repeal of the expansion program if the Idaho Department of Health and Welfare could not receive all 11 waivers required from the federal government. 

Idaho voters in 2018 voted to expand Medicaid eligibility to those who fell in the “coverage gap” by not qualifying for traditional Medicaid and not qualifying for health insurance through the state exchange. As of Feb. 6, more than 80,000 people were enrolled in the Medicaid expansion program, according to the health department website.

The conditions in the bill require the health agency to seek federal waivers to get permission to implement changes to the state's Medicaid program, including adding work requirements, adding an enrollment cap, limiting hospital presumptive coverage and adding a three-year lifetime limit on care in the program.

Bill sponsor Rep. Jordan Redman, R-Coeur d'Alene, introduced a nearly identical bill last session, which died in committee on an 8-5 vote.

Rep. Josh Wheeler, R-Ammon, asked Redman why he included the automatic full repeal of the expansion program if the Department of Health and Welfare was not able to obtain all 11 waivers to the program from the federal government. Wheeler said he would rather the conditions be subject to legislative review.

Redman responded that he thought the threat of repeal would incentivize the federal Centers for Medicare & Medicaid Services, which must approve changes to state Medicaid programs.

“To me, this is the bullets in the gun to kind of force them a little bit,” Redman said to Wheeler. “I think without that, it could sit on a desk and not have any attention to it.”

Redman later apologized for using the phrase “bullets in the gun.”

Wheeler responded, “... What I fear that we have done with the way we currently have the language written, is we’re telling those D.C. bureaucrats they can decide, and we are not putting anything on the line for them. We are putting everything on the line for us and our constituents. … we got the gun pointed at ourselves, not at the bureaucrats.”

Members asked Redman questions about the bill for nearly an hour before testimony began.

Wheeler made a motion to table the bill prior to any testimony based on the concerns he had.

Around 30 people spoke at Wednesday’s hearing, with five in favor and the rest in opposition.

Several of those who opposed it said that leaving thousands of people without insurance would have higher costs to the state, counties and health systems due to delays in preventative care. Those who supported the bill said they wanted to rein in costs of Medicaid and encourage people to work.

Committee members and testifiers said the bill might as well be a guaranteed repeal of expansion if it passes because of the difficulty in obtaining the required waivers.

Redman has said he feels confident the waivers will go through based on the priorities of President Donald Trump.

Hillarie Hagen of Idaho Voices for Children noted that other states have attempted to seek similar waivers, such as implementing work requirements, enrollment caps and lifetime benefit limits, and were rejected under the previous Trump administration. She said although the president has signaled he would favor some of the proposed restrictions, current federal laws and rules do not allow many of them.

Dr. Kelly McGrath, a family medicine physician from Orofino, said the patients he sees who are enrolled in the program are “often experiencing difficult medical conditions or just living through challenging financial times.”

“For those patients, health coverage is a lifeline,” McGrath said.

He also said the expansion of coverage helps “strengthen rural economies.”

Fred Birnbaum, director of legislative affairs at the conservative think tank the Idaho Freedom Freedom Foundation, spoke in favor of the bill.

He highlighted that although around 90% of the Medicaid funds are paid for by the federal government, those were “borrowed dollars,” because of the federal government’s debt. Chris Cargill, of the conservative Mountain States Policy Center, spoke in favor of the bill for similar reasons.

He also argued that the new Trump administration may be more likely to grant the waivers this time around.

“I think it’s a mistake to assume that just because a waiver hasn’t been approved in the past that it won’t be approved in the future,” Cargill said.