The Senate Health and Welfare Committee took testimony Tuesday on a proposal to expand Medicaid, an option available to states under the federal Affordable Care Act. Expansion would provide health insurance to 78,000 working adults in Idaho who do not qualify for Medicaid but do not earn enough to obtain subsidized insurance on the state health insurance exchange. These people are in the so-called gap group.
Why was the hearing significant?
Although Medicaid expansion in Idaho has been thoroughly studied and was recommended by two succeeding governor-appointed workgroups, most of the Republican-dominated Legislature has opposed it. Tuesday’s hearing was the first time lawmakers have convened a hearing on an actual expansion bill.
What happened at the hearing?
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The committee took about an hour of testimony on the expansion bills in what committee Chairman Lee Heider called an “informational hearing.” The committee took no votes on the legislation.
Who spoke on the proposal?
Supporters of Medicaid expansion rallied to attend the hearing, and all but one speaker spoke in favor of the bill. The measure was introduced by Sen. Dan Schmidt, a Moscow Democrat and a family physician.
There are actually two bills, introduced for comparison. The first proposes “straight” expansion as originally set forth under the Affordable Care Act. The second includes certain waivers, pre-approved by the federal Centers for Medicare and Medicaid Services, that address concerns about expansion and give the state some options for implementation. Of the 31 states that have expanded Medicaid, six done so with such waivers – Arkansas, Iowa, Michigan, Indiana, New Hampshire and Montana.
What did supporters say at the hearing?
Those who spoke included an Idaho Falls doctor whose uninsured patient, one of 78,000 Idahoans in the coverage gap, died after an asthma attack; a Nampa woman whose husband’s chronic stomach condition has the uninsured couple $60,000 in debt; and county and city officials and representatives from hospitals and health associations, who cited reduced costs and better health for more people.
Who spoke against it?
The Idaho Freedom Foundation raised often-cited concerns about the long-term viability of federal funding for expansion. Expansion costs are initially 100 percent federally funded. Reimbursement declines gradually to 90 percent by 2020, but opponents like the IFF believe the rate could decline even further if costs and the federal deficit continue to rise, throwing the burden on the states.
Are there other options being considered in the Legislature?
With Medicaid expansion stalled, Gov. Butch Otter’s administration this year proposed a state-funded plan to subsidize basic preventive care for people in the gap group. The $30 million cost of the plan would be covered by existing cigarette and tobacco taxes.
How do the two options compare?
They are completely different. The state plan covers primary care doctor visits only. It is not insurance and does not cover acute or chronic care or prescriptions. Medicaid expansion would provide insurance to cover all conditions.
Do they cost the same?
The state plan would add $30 million on top of the cost of keeping in place the state and county indigent care programs. County programs pay the first $11,000 of such cases; the state Catastrophic health care fund pays the rest. CAT fund costs are dropping as more people have obtained health insurance under Obamacare. Under the state plan, they could increase again as more people go to the doctor for preventive care, find out they’re sick and need treatment that isn’t covered.
The expansion plan would save the state $55 million by eliminating the need for the state and county indigent care programs. So the difference between adopting one program over the other is $85 million.
What are other arguments for expansion?
Beyond projected $173 million in savings to the state over 10 years, supporters cite humanitarian grounds for expansion. States, supporters contend, have a moral obligation to expand Medicaid to improve health options and outcomes for poorer residents. They also cite medical studies that compare mortality rates in states that expanded healthcare to rates in states that have not. The higher death rate in non-expansion states is 19.7 per 100,000 people per year. For Idaho, that’s about 320 people a year.
Where does the discussion go from here?
Nothing has been decided. The Legislature has yet to formally hear proposals for the state-sponsored plan. Those hearings, plus the potential continuation of Tuesday’s hearing, are pending.