House Speaker Scott Bedke said there isn't enough time left this session to tackle the issue, even though he thinks the potential merits of expansion shouldn't be overlooked. It could mean some $478 million in county property tax reductions for Idaho residents through 2024, according to an Idaho Department of Health and Welfare report.
"We are going to be done by Friday," said Bedke, R-Burley. "I don't think we can give that issue the proper vetting it deserves."
Republicans exhausted considerable political capital on another key provision of President Barack Obama's overhaul when they passed a state-based health insurance exchange after 16 hours of debate in the House and Senate. Some backers of the bill were accused by some foes of acquiescing to federal intrusion into Idaho.
Consequently, GOP appetite to tackle Medicaid expansion, a provision of the 2010 federal law that the U.S. Supreme Court left to states to decide, is limited, especially given the bruising debate sure to accompany it.
"Politics are what's going to block it," said House Minority Leader John Rusche, D-Lewiston, a former insurance executive who favors expanding the program.
Among other things, Rusche said, expanding Medicaid would move more than 100,000 low income Idaho residents into a system of health care that includes mental health services, a departure from the existing program that pays the medical bills of poor patients only after treatment.
That program, Idaho's catastrophic health insurance fund, is running about $65 million annually for the state and counties combined, but would be eliminated under Medicaid expansion.
OTTER WANTS REFORMS
Another obstacle to adopting expansion this year is that Gov. Butch Otter continues to oppose it - at least until he wins changes to boost patient responsibility.
Jon Hanian, Otter's spokesman, said Friday nothing has happened to move the Republican governor from the position he took in his Jan. 7 State of the State speech: Idaho should hold off on expanding Medicaid until a broken system has been fixed.
At Otter's direction, the Idaho Department of Health and Welfare has been working since January to secure an agreement from the federal government to allow the state to modify how Medicaid in the state would cover an expanded population. Among other things, Health and Welfare Director Dick Armstrong is seeking changes that promote patient responsibility and encourages providers to focus on outcomes rather than on providing services for which they can bill the government.
'TESTING THEIR METTLE'
Armstrong said Friday he's optimistic about winning an agreement from the U.S. Department of Health and Human Services. He said a new program could be put in place during 2014, Armstrong said Friday, noting officials in Washington have at least verbally offered encouragement. Now, Armstrong said, he wants it in writing.
"We're now testing their mettle," he said. "We're saying, 'You opened the door, we're walking through.' "
Last year, Otter commissioned a 15-member committee to scrutinize expanding Medicaid to more people.
This week, the panel met again to review Health and Welfare's savings projections, and was in the process Friday of sending Otter a letter urging him to back Medicaid expansion.
Idaho Hospital Association president Steve Millard, a member of Otter's panel, conceded it would take nothing short of the full force of the Republican governor's leadership for something to happen this session.
"I don't know if he appreciates the urgency," Millard said. "Our letter shows that in spades, the urgency."