State Politics

Idaho lawmakers block new approach to health insurance for sick and working poor

The Idaho Statehouse in Boise.
The Idaho Statehouse in Boise. Idaho Statesman file

One of Idaho’s biggest advocates for giving health care to this state’s poor still hoped Tuesday to revive the latest attempt to do so.

But Gov. Butch Otter’s legislative proposal to provide health care to some of the state’s poorest residents came to a halt Tuesday after it failed to generate enough support inside the GOP-dominant Statehouse.

Idaho’s House on Tuesday agreed to send Otter’s bill back to committee, rather than ask representatives to vote on the merits of the bill and publicly state how they stand on the proposal.

Doing so signals for the sixth year in a row that GOP lawmakers once again have no appetite to address the state’s so-called Medicaid gap population before the end of the legislative session — particularly in a year where every state lawmaker is up for re-election in May.

“What they ought to do is find a way to bring it back to the floor and enact a solution to the coverage gap,” said Lauren Necochea, director of Idaho Voices for Children. “Idahoans have been clamoring for a solution for years now. ... I don’t think we should let anyone off the hook yet.”

The vote came just days after the Trump administration signaled its support for the proposal. U.S. Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma had indicated Saturday they would support the waivers, state Insurance Director Dean Cameron told the Statesman on Monday. Cameron and Otter both met in person with Azar and Verma in Washington, D.C.

“They applauded our innovation and creativity on the dual waivers,” Cameron said of the meeting. “They said they are looking forward to working with us to get those approved. Of course, we have to get those through the Legislature [first].”

House Speaker Scott Bedke, R-Oakley, told reporters the bill did not have enough to secure a simple majority even with the help of the Democrats. He declined to say exact how many votes the measure lacked.

Otter was traveling in Washington, D.C. His spokesman did not immediately respond to an email seeking comment.

The vote to send the bill back to committee was 53-15, according to The Spokesman-Review. All the chamber’s Democrats voted against shelving the bill; so did Republican Reps. Christy Perry of Nampa, Eric Redman of Athol, Caroline Nilsson Troy of Genesee and Jarom Wagoner of Caldwell.

Lawmakers such as Rep. Karey Hanks, R-St. Anthony, worried the bill was essentially Medicaid expansion, the newspaper reported.

“Every year we have people come in to testify and cry,” said Perry, who is also running for Idaho’s open U.S. House seat. “I do believe after six years of work, that those people and the state of Idaho deserve a vote on this bill.”

Redman, who is retiring this year, added that lawmakers have no excuse to ignore the Medicaid gap population, particularly because the majority of the Legislature has access to state-funded health care insurance.

House Health and Welfare Chairman Fred Wood, R-Burley, asked for the bill be returned to his committee after consulting with legislative leaders and Otter.

“I know 75 percent of the people in Idaho feel like the Legislature should do something, but unfortunately this doesn’t appear to be what we can get the votes at this point in time,” he said.

“How can we know the votes aren’t there unless we take a vote? I know that my entire caucus is there,” said House Minority Leader Mat Erpelding, D-Boise. “This is deeply disappointing.”

Necochea said the bill was created through many compromises.

“This is something Idahoans absolutely want legislators to do, and I think legislators can explain to their constituents that this is a conservative approach,” Necochea said. “[It] not only grants tax credits to Idaho families that have been unfairly excluded, but also reduces health insurance premiums for everyone in the private market, and will also start to bend the cost curve in our indigent care system. ... I think legislators have the opportunity to explain to their constituents and their voters that this bill has many benefits.”

The bill would have:

▪  Allowed some of Idaho’s sickest adults to get insurance through Medicaid, which would take them out of the pool of customers who get insurance through Idaho’s exchange.

The group would include about 2,000 to 2,500 adults who have costly diseases such as stage-4 cancer, hemophilia or cystic fibrosis. Those adults drive about 40 percent of the insurance claims for individual health insurance, according to current and former state officials involved in developing the plan. Removing them from the exchange pool would take out a large chunk of the medical spending that is driving double-digit rate increases, they said.

It wouldn’t be the first time certain categories of patients have been waived onto public health insurance. Medicare has special eligibility for people with kidney failure. Idaho’s Medicaid program already makes an exception to cover treatment for low-income women with breast and cervical cancers.

Characterizing the new proposal as Medicaid expansion would be “a bit of a stretch,” former Idaho Health and Welfare Director Dick Armstrong told the Statesman last fall. “It’s really just taking the same machinery that was in place for breast and cervical cancer and expanding it to other devastating, high-cost disease states.”

▪  Enabled working-poor Idahoans to buy health insurance plans through the exchange.

Childless adults who are below the federal poverty line — $12,060 a year for a single person or $16,240 for a couple — do not qualify for Medicaid in Idaho. They also don’t qualify for subsidized plans on Idaho’s health exchange. Hence, they are in the “Medicaid gap,” numbering an estimated 78,000 people.

Those folks have two options: go uninsured or pay full price for health insurance. Those who go uninsured sometimes end up in the hospital due to a medical catastrophe. When they can’t pay, their bills are ultimately borne by counties, the state and people with private health insurance.

Under the new plan, about 38,000 people who are in the Medicaid gap would qualify for federal subsidies to buy insurance on the exchange.

Audrey Dutton: 208-377-6448, @audreydutton