Medicaid bill held in committee

Idaho lawmakers Thursday held a complicated Medicaid reform bill in committee after doctors and others said it would likely repeal Medicaid expansion and could destabilize health care.

Under House Bill 419, if 11 new requirements weren’t met, Medicaid expansion would have been repealed by October 2025. The bill also called for new work requirements and a ban on Medicaid covering gender-affirming care for adults — policies that Idaho Gov. Brad Little has expressed support for.

The House Health and Welfare Committee on Thursday held the bill in committee, rejecting an attempt to advance it to the House floor after hearing almost three hours of testimony. 

The bill’s sponsor, Rep. Jordan Redman, R-Coeur d’Alene, told the committee the legislation was meant to strengthen Medicaid by ensuring that people most in need maintain access to care, suggesting that the new regulations could help combat abuse and fraud in the program, improve the state’s budget and prevent waitlists for care. 

A representative with a Florida-based conservative think tank, the Foundation for Government Accountability, explained how the bill would work to the committee longer than any other presenter, including Redman. Redman told the Idaho Capital Sun after the hearing that the group helped review the bill.

But several of the almost three dozen people who testified to the committee Thursday said the bill seemed like a way to repeal Medicaid expansion with more steps. That’s because, some said, it relies on a longshot attempt to get the federal government to approve changes to Medicaid, including requests that federal officials have rejected or not approved.

Patients also shared stories about how Medicaid coverage helped them or their loved ones access life-saving health care. Medical industry representatives and doctors said the bill could reduce patient access to care and jeopardize the health care system. 

“This bill would provide a tool to destabilize the system even more at the expense of our more vulnerable citizens,” Idaho Hospital Association government affairs vice president Toni Lawson told the committee. “Instead of adding a bill that could put several thousands of people in the uninsured category, we should be looking at ways to stabilize our health care system and build capacity for the coming years.”

Bill part of Idaho Republicans' broader push to cut Medicaid costs

Idaho Republican lawmakers have in recent years worried about the budget for Idaho’s Medicaid program, a $4.6 billion program funded mostly by the federal government. Redman told the Sun his bill follows up on work by an interim committee last year that was tasked with finding ways to save money in Medicaid. That committee did not come to a conclusion about how to restructure Medicaid funding.

After the Health and Welfare committee heard opposition Thursday from dozens of members of the public, Redman told the committee his goal with the bill is to put sideboards in place for Medicaid, “to help grow it for those who most need it,” mentioning seniors and Idahoans with disabilities. But taxpayers would benefit, too, he said. His bill’s fiscal note estimates it could save the state upwards of $109 million.

“Let’s demonstrate to Washington the right way to do this,” Redman said. 

If all the bill’s requirements weren’t met by July 1, 2025, the Idaho Department of Health and Welfare would have been required to repeal expansion by October 2025. The bill would’ve also required the agency to try to cap enrollment in Medicaid expansion, either at 50,000 people or at the total number of adults on Medicaid who are disabled or age 65 and up.

Idaho lawmakers hold Medicaid bill after doubts, questions

At least two of the only three people who testified Thursday in support of the bill were conservative think tank representatives. 

Foundation for Government Accountability Deputy Policy Director Scott Centorino was asked several times by lawmakers about the waiver’s likelihood of success. He said requests to the federal government could be combined into one waiver, which he said, evaluated together, would show savings for the federal government. 

House Minority Leader Ilana Rubel, D-Boise, said she doubted that the waivers would all be approved.

House Majority Leader Megan Blanskma, R-Hammett, was one of five Republican legislators who voted to hold the bill in committee, along with the three Democratic legislators who serve on the committee. Blanskma said she had “serious questions,” mentioning her work for Idaho’s unsuccessful attempt at pursuing Medicaid work requirements in 2019.

“I want to know if we’re getting slow rolled by our Department of Health and Welfare, or if it’s a federal problem,” she said about Idaho’s existing, unapproved Medicaid work requirement waiver. That original bill, she said, was “the most painful bill I’ve ever negotiated.”

And then there’s the “elephant in the room,” Blanksma said, pointing to the elimination of the Catastrophic Health Care Fund, a state program nixed after Medicaid expanded that provided loans to people who need help with high health costs.

Rep. Jacyn Gallagher, R-Weiser, moved that the committee send the bill to the House floor, without a recommendation that it pass, so more legislators could weigh in. 

Idaho Freedom Foundation Legislative Affairs Director Fred Birnbaum supported the bill, pointing to its requirement that federal regulators approve the waivers for Idaho’s Medicaid expansion to remain in effect and said that the sideboards show savings for the federal government. 

“This is a completely new innovative approach that flips the script,” Birnbaum said.

But several doctors challenged those portrayals of the bill.

‘Death sentence:’ Health care representatives widely opposed the bill

The bill, Lawson said, “holds health care for Idahoans hostage” unless federal regulators approve the sideboards. Lawson said the Idaho Hospital Association was not consulted about the legislation when it was drafted. The group would have supported several policies within the bill, she told the committee.

“This would not be a rescue mission. This would be a death sentence,” said Dr. Loren Colson, co-president of the Idaho Coalition of Safe Health Care.

The bill “is designed to defy the wishes of ordinary Idahoans,” said Dr. Jonathan Chu, a retired Idaho physician. 

Several people who collected signatures to get Medicaid expansion on the ballot also reminded the committee that 61% of Idaho voters approved Medicaid expansion in 2018. Some pointed to independent polling that shows support has grown since then.

“I can’t believe constituents have to continually come back and defend threats to this law that Idaho voters passed by a landslide,” said Sam Sandmire, who gathered signatures and was the final person to testify.

‘Vulnerable’ patients would face the bill’s impact

Christine Curry, 73, recalled at the hearing how her young, healthy son found out he needed open heart surgery. 

If Curry had to pay those bills, it would’ve made her “financially destitute.” But Medicaid paid the bills, she said, and her son recovered. 

He’s doing well in school in Bozeman, she said, and she hopes he comes back to Idaho to work in environmental research.

But if he hadn’t gone to the doctor, he would’ve died, she said.

Before Medicaid expansion, Jennifer Johnson, a Boise mother of two twins, was between jobs and in the “Medicaid gap,” which refers to a gap in health coverage assistance programs in Idaho that existed before Medicaid expansion. People in the gap made too much for Medicaid, but too little to get subsidies on Idaho’s insurance exchange, Your Health Idaho.

But since expansion, she and her twins who have serious medical conditions are covered under Medicaid expansion. If that went away, she worries she’d be back in the gap and stuck with unaffordable health insurance costs.

“Please help people like me keep the coverage we rely on to ensure that we can run small businesses without having to choose between food, housing or medical,” she said.

After Carol August, a retired in-home health care worker, got on Medicaid through expansion, she could afford surgery for cancer, she said. Her job didn’t provide health benefits. 

“I know that legislators are concerned about the Medicaid budget, but I say that Medicaid saved my life,” she said. 

For Idahoans on Medicaid who already work two, maybe three jobs, “the last thing they need is an additional layer of bureaucracy to get treatment,” said Randy Johnson, government relations director for the American Cancer Society Cancer Action Network.

Dr. Amelia Schurke, a family physician in Boise, told the committee about the patients she sees, who mostly rely on Medicaid: Children coming in for wellness visits, people seeking mental health help, people with addictions, and many refugees. 

Many of her patients don’t speak English or don’t have child care. Repealing expansion would hurt them, who she says “are already some of the most vulnerable.”

“That is not the Idaho I plan to serve,” Schurke said. “… I expect better from my state.” 

Dr. Andrea Christopher, who treats veterans, reminded the committee that Idaho is already 50th in the nation for the number of physicians it has, relative to its population. Health care workers are leaving the state at a high rate, she said.

“Let’s not continue that trend,” Christopher said.

David Lehman, who represented a behavioral health provider and AARP, said the bill comes from the wrong place.

“This bill asks Idaho to jump off a cliff, and try to build a plane before we hit the ground,” Lehman said. “I think the alternative is, 'Let’s build this plane on the ground first, and see if we can get it to fly.'”

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501(c)(3) public charity. Idaho Capital Sun maintains editorial independence.