Thousands of Idahoans could lose health care coverage under federal spending bill

Early estimates show around 40,000 Idahoans could lose Medicaid coverage and an additional 35,000 people could lose their health care insurance through the state marketplace under the sweeping budget reconciliation bill passed Thursday by Congress.

Idaho’s Republican congressional delegation, two senators and two House members, supported the bill. 

U.S. Sen. Mike Crapo said Sunday on the Senate floor that the bill was “rooting out waste, fraud and abuse in federal spending programs, like Medicaid,” a contention that health care advocates dispute.

Idaho’s House representatives supported both an earlier House version of the bill, the Idaho Press reported, and the updated version, created by the Senate, with about $100 billion more in cuts to Medicaid over 10 years.

The changes made in the Senate version passed on Tuesday were approved by the House Thursday and will go to President Donald Trump for his signature.

The Senate version cuts nearly $1 trillion from Medicaid over 10 years

The Senate version of the budget and tax cut bill is expected to cut federal spending on Medicaid by around $1 trillion and increase the number of uninsured Americans by 11.8 million over the next 10 years, according to a preliminary estimate from the Congressional Budget Office.

Erin Riley, outreach and engagement coordinator with the advocacy group Idaho Voices for Children, said the estimates in health care reductions are “conservative,” and many of the losses of coverage would be due to increased paperwork under new requirements in the bill. 

“In general, we might see people losing their Medicaid coverage because of eligibility, … but it’s a lot of paperwork,” Riley said. “It’s death by 1,000 cuts. So folks that would probably be eligible for traditional Medicaid, they might get caught up in that cycle of not being able to report that they are eligible. There’s just a lot of red tape.” 

Under the bill, able-bodied adults would be required to work or conduct “work-related activities” at least 80 hours a month and prove eligibility and compliance every six months. There would be exceptions for parents of children under the age of 14. 

Idaho is also pursuing its own work requirement through House Bill 345 for those who are insured through Medicaid expansion — a program approved by voters in 2018 to extend Medicaid eligibility to those who earned too much to qualify for traditional coverage but not enough to qualify for the premium tax credit to get health care coverage through the state marketplace. 

The state’s changes to Medicaid will need to be approved by federal authorities before going into effect.

Crapo says bill protects Medicaid coverage for those it was intended for 

The broad-reaching bill extends tax cuts approved in 2017, during the first Trump administration, that mostly benefit wealthy people, critics and some experts say. The bill, among many provisions, also enhances funding for the military and immigration enforcement, ends renewable energy programs approved by the Biden administration, and reduces funding for some public assistance programs, such as Medicaid and food assistance through the Supplemental Nutrition Assistance Program, known as SNAP. 

Crapo, who serves as chairman of the Senate Finance Committee, said that the bill would protect benefits “for whom Medicaid was intended,” including pregnant women, children, seniors and those with disabilities; Crapo didn’t include in his remarks low-income residents, who were eligible after states were able to expand Medicaid following the passage of the Affordable Care Act. 

He argued that programs that enroll healthy Americans and undocumented residents have been driving up the program’s costs. 

“This rate of expansion is unsustainable and puts the future of the program at risk,” Crapo said on the floor. 

U.S. Sen. Jim Risch’s office said in a press release that one of the achievements of the bill he supported was it preserved “Medicaid for vulnerable Americans by enacting common-sense reforms that prioritize resources for those who need care.” 

Rep. Mike Simpson’s office could not be immediately reached for comment on the Medicaid portion of the budget bill, but said in an emailed statement the bill “is the America-First policy agenda that Idahoans and Americans nationwide voted for in November.” 

U.S. Rep. Russ Fulcher’s office also could not be immediately reached for comment. He said in a press release that he voted Thursday to “deliver what effectively will result in the single largest tax cut in American history for the American People, and to bolster border and military resources to keep our communities safe.”

In a statement, Idaho Democratic Party Chair Lauren Necochea sharply criticized the votes of Idaho’s congressmen.

“Idaho Democrats believe hard work should mean a roof over your head, food on the table, healthcare you can count on, and a fair shot for your kids. Mike Simpson and Russ Fulcher just voted to rip that away,” she said. “They backed a Republican budget that pushes the American Dream further out of reach for working people, while catering to billionaires with penthouses and private jets.”

Senate version of bill does not extend health care premium tax credit

The spending bill does not extend the enhanced premium tax credits, which were passed by Congress through the American Rescue Plan Act to reduce health care premiums through the marketplace established in the Affordable Care Act. The enhanced credits are slated to expire this year, and if Congress does not extend them, many people would see their premiums “skyrocket,” Riley said. 

On average, the tax credits have reduced premium payments by $705 a year, according to the health care policy organization KFF. 

Increases could be more significant for some groups. 

An estimate by Idaho Voices for Children shows an Idaho couple in their 60s, making $82,000 a year, would see their annual premiums rise from $6,970 to over $22,222. 

“With that high premium cost, we’re going to see people drop off because they’re just not going to be able to afford coverage,” Riley said.