State Politics

Idaho House kills Medicaid expansion bill

House Republicans Friday gave the decisive last word on the session-long debate over funding health care for 78,000 lower-income Idahoans, voting unanimously to kill a Senate-approved bill to move the state toward a federally-approved, Idaho-driven solution.

After lengthy morning caucuses of party leaders and then the rank-and-file, Republicans moved not to accept the amended version approved in the Senate Thursday.

“I think we are well aware that the amendments have considerably changed the intentions of the bill,” said Rep. John Vander Woude, R-Nampa, the GOP majority caucus chair. “I can no longer support what’s been added to it.”

The Senate change reversed a move by the House to advance a more modest step aimed at helping the so-called gap population below the federal poverty line but ineligible for Medicaid assistance. Provisions of the 2010 Affordable Care Act include expanding Medicaid to cover that population.

An earlier bill floated in the House authorized the state Department of Health and Welfare to seek a federal waiver so Idaho can customize a plan using federal Medicaid dollars. The state would seek a block grant to pay for a managed-care program for the people in the gap group, relying on the state’s community-based programs that emphasize primary and preventive care and move away from the fee-for-service health care model that many believe drives up costs.

Immediately after the House adjourned for the year, Speaker Scott Bedke said he would seek to appoint a joint bipartisan panel of lawmakers to review the gap coverage issue starting in May.

“We have a very clear commitment in the caucus that we will take this issue up with real intent,” Bedke said. “I think that I speak for nearly everyone in the caucus that this is Job 1.”

Minority Leader John Rusche, D-Lewiston, said Democrats would call on Gov. Butch Otter to proceed with seeking the federal waiver using his executive authority or call the Legislature into special session to address the issue.

Rusche dismissed the idea of another working group to study the issue, noting previous studies and the failure of last year’s tax working group to produce anything of substance.

“This issue has been studied to death, with professionals who know health-care policy and health-care finance,” Rusche said. “Maybe we’ll get them to move next year, but in the meantime, Idaho should be disappointed in what Republicans have done to them.”

The Senate completed its business and adjourned Thursday night.

WHAT LED TO FRIDAY’S DRAMA?

On Thursday, the Senate resurrected the proposal to begin negotiations with federal officials for a way to provide the subsidized health care for uninsured Idahoans.

Thursday was a hectic last full day for the Legislature, dominated by the most critical topic before the Legislature this year. The Senate rejected more modest, incremental proposals approved Wednesday by the House, after support for the waiver option collapsed among the majority Republicans.

After amending the House bill to add back the waiver option on Thursday morning, the Senate approved and sent it back to the House Thursday afternoon. The House took up the accompanying funding bill in Thursday evening and passed it 40-29, but put off a vote on the policy bill until Friday.

“They either concur or they don’t concur,” Senate President Pro Tem Brent Hill said Thursday night. “I don’t think we’re disadvantaging them in any way if we (adjourn).”

OTTER WEIGHS IN

Otter told the Times-News Thursday that he supports beginning the Medicaid expansion waiver application process as soon as possible. “The sooner that we can start that, the better prepared we’re going to be,” he said.

Otter declined to comment on whether he would consider executive action if the Legislature doesn’t act, saying he wanted to first see what lawmakers do.

The bill authorizes the state Department of Health and Welfare to seek a federal waiver so Idaho can customize a plan using federal Medicaid dollars. The state would seek a block grant to pay for a managed-care program for the people in the gap group.

Central to the plan is its reliance on the state’s community-based programs that emphasize primary and preventive care and move away from the fee-for-service health care model that many believe drives up costs.

A bipartisan legislative committee would monitor the state’s application. If approved by the federal government, the Legislature would vote on it next year, with implementation to start sometime in 2017.

The move aims to address Republican opposition to implementing Medicaid expansion under the 2010 Affordable Care Act, by getting federal approval for a program that gives the state greater control over how the dollars are used.

“This does not say we are approving any kind of waiver process for expansion,” Sen. Marv Hagedorn, R-Meridian, said on the Senate floor. The action, he said, would allow Idaho “to start the waiver negotiation and application process.”

RECONCILING COMPETING EMOTIONS

Opposition to Medicaid expansion in any form persists in both houses. It helped kill the plan in the House earlier this week and was apparent in the Senate debate Thursday.

“If you are opposed to Medicaid expansion, I can’t find any reason to vote for this amendment,” said Sen. Steve Vick, R-Dalton Gardens.

During Senate debate on the amended bill, comments from lawmakers showed the struggle some have had reconciling opposition to federal entitlements with a desire to help the gap group.

“There is no right to health care. Not one of those who left the bloody tracks in the snow at Valley Forge did so for free health care,” said Sen. Jim Rice, R-Caldwell. Nonetheless, he voted to seek the waiver.

Bill Dentzer: 208-377-6438, @IDSBillD

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