‘One accident away from bankruptcy': Idaho House passes bill to gut Medicaid expansion

Yahoo

20-02-2025

When a bill that could slash health care coverage for tens of thousands of low-income Idahoans was introduced in the Legislature, Rep. Megan Egbert, D-Boise, said she got an angry voicemail from a farmer in Central Idaho who mistakenly thought she supported the measure.
Long bemoaned by many Republicans, whose inaction led state voters to approve Medicaid expansion in an initiative in 2018, the program was freshly targeted this year. House Bill 138, sponsored by Rep. Jordan Redman, R-Coeur d'Alene, would cut off Medicaid expansion unless a set of 11 conditions are met — several of which would require federal approval that historically has not been forthcoming.
House Bill 58, sponsored by Rep. Josh Tanner, R-Eagle, would repeal Medicaid expansion outright.
It was HB 138 that the Central Idaho man was upset about. Egbert said on the House floor Wednesday that having exclusively received feedback from people opposed to the bill, she informed him that she was, in fact, against it. And if legislators voted to move the bill along, they should expect a call from that farmer.
Lawmakers' phones could be ringing soon — the bill passed the House by a 38-32 vote, earning quick condemnation from minority Democrats.
'It winds us back to a time when tens of thousands of Idahoans were one accident away from bankruptcy and losing everything they had,' said House Minority Leader Ilana Rubel, D-Boise.
Redman said at a public hearing that his proposal aims to rein in Medicaid spending and prevent what Republicans have said are 'skyrocketing' costs. He asserted that his bill would simply introduce guardrails but keep the program alive.
'This bill does not kill Medicaid expansion,' he said.
But outside experts and even some Republican lawmakers said meeting all 11 conditions required to maintain the program has little chance of happening, the Statesman reported. Those include limiting the number of participants to 50,000 enrollees, adding work requirements, capping program participation at three years and cutting down on improper payment rates.
Overall, more than half of the conditions would require waivers from the Centers for Medicare and Medicaid Services. The result is that the bill effectively just becomes a repeal of voter-approved expansion — but Rep. Wendy Horman, R-Idaho Falls, said Wednesday she was 'willing to take the risk.'
'I think the risk of not acting leaves us in a very vulnerable position,' she said.
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 GOP-dominated Idaho Legislature never did expand offerings to those in the so-called coverage gap — they earned too much to qualify for standard Medicaid but not enough for private insurance discounts. The number of Idahoans in this gap numbers about 90,000, according to the Idaho Department of Health and Welfare.
This led Idaho residents to bring forth a successful ballot measure in 2018, and Medicaid expansion has been in place in Idaho since then.
HB 138's supporters say the cost of the program 'is not sustainable,' to use Horman's words. Rep. John Vander Woude, R-Nampa, said in a January hearing that the program's expected costs for the state went way beyond what lawmakers expected: from $32 million in projected costs in 2018 to $110 million in fiscal year 2026.
The federal government, however, pays 90% of the costs of Idaho's Medicaid expansion, but Republican lawmakers have repeatedly said the Trump administration might lower the payment threshold as it targets federal spending.
At a public hearing last week, more than 300 people signed up to testify against Redman's bill compared to just 17 who signed up in favor — about an 18-to-1 ratio. The House Health and Welfare Committee then advanced Redman's bill by a single vote, with five Republicans joining two Democrats in opposition.
Now narrowly passed by the House, with 23 Republicans joining all nine Democrats to vote against, the bill heads to the Senate for consideration. Tanner's bill has yet to have a public hearing.
What might happen in Idaho without Medicaid expansion was still an open question Wednesday. Counties might need to cover the cost of indigent residents' medical bills, said Rep. John Weber, R-Rexburg. He also wondered whether the private sector might extend coverage to people previously in the expansion program.
Without a clear plan, Rubel warned that Idaho was simply returning to the 'terrible' time before voters OK'd Medicaid expansion in 2018.
'Spoiler alert: It was not a magical wonderland here before we passed the Medicaid expansion, where people pulled themselves up by their bootstraps and everybody had coverage, and everybody just worked that much harder,' she said.
Tens of thousands of people couldn't get coverage, Rubel said, and 'people were dying from preventable illnesses.'
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