The Republican bid to overhaul national health care is unlikely to spur any immediate action in the Idaho Legislature this year due both to timing and to uncertainty over elements of the new plan, not to mention its overall prospects for passage.
After Tuesday, 13 legislative days remain before the state Legislature’s scheduled adjournment, a time frame rendered all the more urgent as lawmakers from winter-worn regions across the state worry about imminent impacts from spring thaws.
Further, the GOP-backed American Health Care Act announced by members of the U.S. House Monday already has split Republicans nationally, with more conservative wings deriding it as “Obamacare Lite.” In a different camp, four Republican senators from states that would lose funding also have vowed to oppose it.
Beyond those issues, Idaho officials were sorting through provisions of the Republican bill looking for potential impacts.
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“There are so many questions that have to be asked and answered before the state can do anything,” said Rep. Fred Wood, R-Burley, chairman of the House Health & Welfare Committee.
The state Department of Health & Welfare was similarly uncertain. Department spokeswoman Niki Forbing-Orr said the Republican proposal “seems terribly confusing, and we’re not sure how to interpret it just yet.”
Republicans have proposed outright repeal of some Obamacare elements while changing or keeping others. Among those slated for repeal are individual and employer mandates and certain subsidies for deductibles and co-payments.
It is not clear how those and other changes will affect state-based health insurance exchanges such as Your Health Idaho, which saw another record enrollment this year. No independent financial analysis of the congressional plan has yet been done.
Also immediately relevant to Idaho is how the GOP proposal addresses the Medicaid expansion component of the 2010 Affordable Care Act, or Obamacare. The ACA provided health coverage for millions of lower-income Americans by extending Medicaid coverage to adults at or below 138 percent of the poverty line.
The coverage would be 100 percent federally funded for the first three years, declining gradually to 90 percent thereafter.
After Obamacare provisions were challenged in court, states were given the choice of adopting expansion; 31 states did. Idaho is among those that did not, leaving an estimated 78,000 residents without coverage.
The Republican plan proposes substantial changes to both regular and expanded Medicaid, but retains expansion through 2019. States that expanded can continue to enroll people, and states that haven’t expanded can still change course and opt in.
In 2020, however, new enrollments under Medicaid expansion would end, prompting an expected decline as enrollees eventually drop off.
Regular Medicaid also would change under the Republican plan, with aid to states delivered in a lump sum for each recipient. The current federal government commitment is open-ended.