The Idaho Legislature took dramatic steps toward concluding its business for the year Thursday as new legislation on improving healthcare for the poor emerged in one legislative committee while a tax cut proposal died in another.
“This is how you make sausage in a democracy,” said Rep Fred Wood, R-Burley, the chairman of the House Health and Welfare committee, as his panel Thursday tabled action on two healthcare bills in preparation for hearing a new one on Monday.
With only one week left till expected adjournment, tax and healthcare initiatives have loomed as the largest unknowns for the session. Lawmakers for years have pushed for action to reduce the state’s top income tax rates and implement other tax changes to make the state more competitive with its neighbors.
This year’s effort, led by House Majority Leader Mike Moyle, was an income tax cut passed early in the session by the House but held ever since in Senate committee. The committee killed the bill Thursday, effectively ending any tax cut action this year.
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At the same time, since the 2012 creation of Idaho’s health insurance exchange via the federal Affordable Care Act, the state has wrestled with finding a solution for the estimated 78,000 low-income residents who do not qualify for health coverage through Medicaid or subsidized insurance via the state exchange.
Two governor-appointed panels have recommended expanding Medicaid under the ACA, but that avenue has been blocked in the Legislature by Republican opposition to federal entitlements or further cooperation with Obamacare.
That opposition has gradually eroded, most dramatically this year. Gov. Butch Otter’s original budget proposal included a state-sponsored, state-funded plan to help the gap group, but its modest provisions prompted lawmakers to look at a broader subsidized program, perhaps via a federal waiver similar to what other states have received to customize their programs.
That’s the approach in the House bill, details on which came out late Thursday. The legislation now being drafted would authorize the Department of Health and Welfare to draw up a waiver plan to submit to the federal Centers for Medicare & Medicaid Services, known as CMS. If CMS approves, the plan will come to the Legislature next year for another sign-off, with implementation starting sometime in 2017.
The Idaho Accountable Care Waiver Act would draw tight parameters on the type of program envisioned for Idaho. It would rely on some of the successes of community-based care programs that emphasize primary and preventive care, instituting a Medicaid-funded managed-care program for those whose income is at or below the federal poverty level.
Medicaid expansion, as set forth under the ACA, extends coverage for those with incomes up to 138 percent of the poverty level. Idaho’s waivered program, if approved, would not address that population because the state estimates that 75 percent of that group already has enrolled in the state health insurance exchange.
“We have an opportunity to look at a managed-care model for our existing Medicaid recipients and every Idaho resident,” said Rep. Kelley Packer, R-McCammon, the committee vice-chair. “We have an opportunity to do this right and it will save our state money.”
Wood said the Legislature “is now talking about what we should do, as opposed to whether we should be covering this gap population.” He urged members to be available through the weekend and ready to take up the legislation first thing Monday to move it quickly to the House floor.
To pass in the House, any plan would need at least 22 of 56 Republican members, assuming it gets the body’s 14 Democrats. Wood acknowledged the potential hurdle among Republicans, noting that winning consensus among the group is “worse than herding cats.”
“Let’s not paint ourselves into any corner where we start getting into a fight within the House of Representatives about how we’re going to help, and therefore stumble again. I don’t want to see that,” Wood, a retired physician, told the committee.
House Democrats appeared ready to embrace the plan.
“It’s kind of like a dam has broken,” said House Minority Leader John Rusche, D-Lewiston, a committee member and a physician. “If it meets the needs and uses the available funds, makes financial sense and clinical sense, Democrats are going to support it.”
Thursday’s action was taken as a session breakthrough. The committee’s hearing room was filled to capacity with advocates who have pressed the Legislature to “close the gap.”
“I think this is a significant victory,” said Brian Whitlock, president and CEO of the Idaho Hospitals Association. “We determined, early on in the session, that there is a need, and there was consensus on the fact that we had to do something more.”
Equally significant, though less dramatic, was the collapse of support Thursday for the tax cut plan. Moyle’s bill had proposed dropping the top two personal income tax rates by one-tenth of a percentage point and increasing the grocery income tax credit to provide some tax relief for lower-income wage earners.
Moyle presented the bill to the Senate Local Government and Taxation committee Thursday, but no one on the committee moved its passage. A motion to send the bill for amendments died for lack of a second.
Senate Democrat, citing fairness, gives up health insurance
A Senate Democrat who has pushed for action on Medicaid expansion to help the “gap group” who can’t get health insurance said Thursday he would forgo state-funded health benefits for himself and his wife.
“It’s just not quite fair that I get that benefit and this Legislature can’t give that benefit to approximately 78,000 Idahoans who can’t afford it,” said Sen. Dan Schmidt, D-Moscow, who is also a physician. “I want people to think about this. I want to start a conversation.”
Schmidt said he and his wife don’t have other insurance and would probably apply for it on the state healthcare exchange.
Schmidt in January presented a Medicaid expansion bill to the Senate Health & Welfare Committee. That bill did not move forward. He also resigned this month from the state board that reviews and approves catastrophic health claims submitted by people who can’t afford to pay. The program would be unnecessary if the gap group could obtain health coverage.
“To me our state has a problem,” he said. “We have a lot of low-income folk working minimum wage jobs. It’s tough for them to get health insurance. We can help our state be more prosperous, more productive, if we can solve this problem.”
He said he welcomed a new health-insurance initiative announced Thursday in the House and said he hoped to be able to support it.