Idaho's House Bill 138 threatens voter-approved Medicaid expansion

Yahoo

21-02-2025

Montana's redetermination dashboard cites the most frequent reason for disenrolling as a lack of correspondence with the department. (Getty Images)
Sometimes, it seems the Idaho Legislature treats residents more like badly behaved children than the people who hired them.
Case in point: The proposal to change the state's Medicaid expansion program, which was put in place after 61 percent of voters passed it in 2018. By one vote, House Bill 138 by Rep. Jordan Redman, R-Coeur d'Alene, passed out of the House Health and Welfare Committee on Feb. 12. The measure passed in the House 38-32 on Feb. 19 and is now in the Senate.
At best, this is a raspberry blown to state voters in the guise of saving money. But can it really save as Redman says?
Looking to the long-term, erasing Medicaid expansion can cost the state millions of more dollars than it saves. Why? Medicaid is an insurance program for the very poor, and currently, Idaho's Department of Health and Welfare reports 450,000 residents are covered by Medicaid, including the 89,000 enrolled in the expansion. These are families of four or more who make less than $3,193 a month or individuals who make less than $1,563 a month and have no insurance from their employers.
The problem with eliminating such coverage for the poor is they will wait until a simple illness becomes severe before being seen by medical professionals. By waiting for care because they cannot afford it, their medical problem becomes worse and they need more – not less – care and costs. Often this care needs to be subsidized by the state. Nationwide, the Kaiser Family Foundation estimates that poor families (making less than $40,000 per year) hold about $195 billion in medical debt. This can further deter people from seeking medical help.
This means the state is creating a hole many residents cannot dig their way out of thanks to low wages and steep medical bills. Add in, the Department of Health and Welfare reports 24 percent of the individuals covered have a primary diagnosis of a serious mental health issue. Medicaid allows these people to access a wider range of behavioral health services so they can get proper treatment.
As for saving the state money, Idaho Health and Welfare reports hospitals spent $42 million less on charity care and had $61 million less debt during the COVID pandemic. That translates into state savings as people who might become sicker were provided with quality care. This is all thanks to the 2018 Medicaid expansion.
Report: Federal funds for Idaho Medicaid expansion spurs $1.5 billion in economic output
Redman's bill would require Idaho to enact 11 Medicaid policy changes or repeal the voter-approved expansion. Some of Redman's changes include work requirements, capping expansion enrollment, a three-year lifetime limit of access to the program along with possibly repealing the expansion altogether. If House Bill 138 is passed, the state will still need approval of the federal government for many of the proposed changes.
While Redman claims his bill does not eliminate Medicaid expansion, the measure does clearly repeal the expansion if the elements of the bill are not in place and functioning by July 2026.
Redman called the proposal the 'bullets in the gun to kind of force them a bit.' Redman later apologized for the analogy, but it did indicate his intention to pressure the federal government into allowing the state change.
During testimony before the House committee, the comments were overwhelmingly negative. Idaho Press journalist Laura Guido reported several people who opposed the bill were concerned this would be a cause for full repeal in addition to the threat of leaving thousands of people without insurance triggering higher costs to the state, counties and health systems due to the expected delays in preventative care.
As Dr. Kelly McGrath of Orofino told the committee, such health care is not only cost-effective, but also a lifeline for many families who have difficult medical conditions. By providing care, McGrath said those patients can strengthen rural communities because they can be productive citizens.
While the bill's proponents say they want something to encourage people to work, people with serious medical (physical or mental) conditions who cannot receive care have difficulty finding a job, much less retaining one.
Medicare expansion may not be everyone's cup of tea, but keeping it in place is indeed a lifeline for thousands of Idahoans who can get the care they need so they can work and keep their families together.
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