Idaho Republicans retreat from Medicaid expansion plan this session

Idaho House Republicans backtracked Wednesday from taking a significant step toward addressing the health care needs of 78,000 poor Idahoans, instead pushing forward two incremental measures that critics labeled “woefully inadequate” and a needless delay.

The move came as the Legislature rushed to complete its work for the year and adjourn, and days after the House appeared ready to embrace much more decisive action on health care for the poor, support for which collapsed over the weekend. Two bills introduced in the morning were passed by the House in the afternoon and sent to the Senate. A Senate hearing is scheduled for Thursday morning.

“This is a small step,” Rep. John Vander Woude, R-Nampa, the House GOP caucus leader, said during a charged House floor debate. “This isn’t intended to cover the whole gap and provide them with all their needs. But this is a step in the direction that I think we need to go.”

The Legislature now is eyeing a Friday adjournment, with action still expected on issues including urban renewal, a few appropriations bills and a House tax cut plan scheduled for a vote Wednesday, then tabled.

The House Health & Welfare committee and the House passed one bill to create a legislative committee to study yet again the needs of the so-called “gap” population — those whose incomes are too high to make them eligible for current Medicaid and too low to allow them to apply for subsidized health insurance under the Affordable Care Act.

A second bill provides $5.4 million to help the current health care system collect more data on that population and provide nominal additional support for health services.

The move for more study comes after two governor-appointed task forces, in 2012 and 2014, recommended that the state expand Medicaid as provided under the 2010 health care law but via a federally approved waiver that lets the state modify how the funding is applied.

Rep. Lynn Luker, R-Boise, presenting the measures on behalf of the Republican leadership, said the Legislature “has not had its own opportunity to sit down and review all of that.”

Supporters on the committee acknowledged that the action was less than they wanted but the most they could achieve this session. Referring the matter to a legislative committee delays meaningful action on Idaho pursuing a federal waiver for a state-driven custom Medicaid expansion plan.

“I was hopeful that we would maybe make a little bit faster track, but at least we’re still moving toward finding the right solution: a waiver here in Idaho that would allow for managed care,” said Rep. Kelley Packer, R-McCammon.

Committee chairman Rep. Fred Wood, R-Burley, noted that conventional Medicaid expansion as set forth under the health care law was “never going to go anywhere” in Idaho.

Under a proposal that surfaced last week, Idaho would have sought approval for a managed-care health program for the gap group using the state’s fledgling performance-based, community-centered health care system that moves away from the fee-for-service model for patient care.

“We were only going to get to Medicaid expansion when we had a system where we could measure outcomes, we could control costs, etc.,” Wood said.

The committee’s two Democrats denounced what they described as another costly delay in addressing the needs of the gap population.

“We’re wasting money and we’re exposing Idahoans unnecessarily to premature death,” said Rep. John Rusche, D-Lewiston. “Further delay with another study will not save lives, will not save money, and therefore I think it’s the wrong decision.”

Rep. Brandon Hixon, R-Caldwell, joined the Democrats in opposing the measures, calling them “not a viable solution.”

Health care system representatives and state health officials were sharply critical. Expansion would deliver new federal dollars to fund health care for the gap group and eliminate state and county expenses for medical bills when someone can’t pay. Instead, the state is opting to pay a little more into a community-based health network that already gets federal funding, without eliminating other costs.

“All they’ve done is make themselves a little bit pregnant on this issue, without addressing the real needs that exist,” said Brian Whitlock, Idaho Hospitals Association president and CEO. “The sad thing is there are a majority of members in the House of Representatives that actually wanted to do something substantive and meaningful this session, and rather than do that they are doing something that won’t even make a dent.”

Health and Welfare Department Director Richard Armstrong said the Legislature had acknowledged that people in the health care gap “are in desperate shape, that they are struggling,” but that the action before the House “doesn’t give me the authority to begin the waiver process with the federal government, so it pushes it out for at least another year.”

The proposed funding is “woefully inadequate,” he said. A plan floated this session for $30 million in new state health care funding “was the minimum to give some kind of meaningful care to the whole population. Five million simply won’t do that.”

This story was originally published March 23, 2016 at 12:49 PM with the headline "Idaho Republicans retreat from Medicaid expansion plan this session."