State Politics

Idaho lawmakers’ impasse on Medicaid expansion persists

Health care panel debates options for Idaho's working poor

The panel of Idaho lawmakers reviewing options for improving health care for the state's working poor heard from an expert on state Medicaid options and from an Idaho Falls family doctor who only takes cash and often gets tips from patients.
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The panel of Idaho lawmakers reviewing options for improving health care for the state's working poor heard from an expert on state Medicaid options and from an Idaho Falls family doctor who only takes cash and often gets tips from patients.

Idaho lawmakers assessing health care alternatives for the state’s working poor demonstrated again the divisions that make it unlikely they will reach consensus on a bill for the Legislature.

Half of a 10-member panel of legislators voiced outright opposition Monday to any version of Medicaid expansion to cover the estimated 78,000 Idaho adults who have no health coverage. That so-called gap group either earns too much to qualify for existing Medicaid or too little to be eligible for subsidized insurance on the state health care exchange created under the 2010 Affordable Care Act.

Expanding Medicaid to cover such populations was part of the ACA, known popularly as Obamacare.

After hearing contradictory viewpoints from outside health experts and providers, the panel heard similarly offsetting proposals from two of its members, with one calling for straight Medicaid expansion and the other offered a far more modest plan funded only by the state.

This impasse is exactly where the Legislature has stood since governor-appointed panels in 2012 and again in 2014 recommended expansion for the cost and health benefits it promises.

Legislators who support expansion cite the windfall of federal health care dollars that would allow Idaho to eliminate expensive, inefficient state and county catastrophic care programs, inject millions into the state economy and address the health care needs of the state’s less fortunate.

I’m having to set aside some political and philosophical biases that I have and recognize the public opinion that’s out there that’s overwhelming, the economic data that’s out there that’s overwhelming.

State Sen. Jim Guthrie, R-McCammon, who leans toward expanding Medicaid

Opponents say expansion does nothing to change the systemic expense of health care delivery and therefore does not help contain costs. They also oppose expansion of federal entitlements as too expensive or too generous.

“We have to take into the consideration that there are those in the 78,000 who could pay for their health insurance if they just worked a little more,” said Sen. Patti Anne Lodge, R-Huston.

Deborah Bachrach, formerly director New York state’s mammoth Medicaid program and now a health care consultant to states on implementing Obamacare’s Medicaid coverage provisions, reviewed in detail how other states have gained federal waivers for modified implementation of Medicaid expansion.

She covered both policy and economic considerations, noting that expansion states had seen windfall drops in their rates of uninsured and costs of uncompensated care, as well as stabilization of rural hospital systems and broad economic benefits statewide.

Following her was Dr. James Brook, a family doctor from Idaho Falls who keeps patient costs down by not taking insurance, accepting cash payments only, and, in a few cases, barter payments. He told lawmakers he collects 101 percent of his bills, the extra coming from patient tips.

The panel also heard from the operations director of Washington state’s Project Access Northwest, a 10-year-old nonprofit that relies on donated health services to provide care to those who fall outside the state’s Medicaid expansion population, such as undocumented immigrants, and gives subsidies to qualifying patients who have coverage but cannot afford their premiums.

Sen. Steven Thayn, R-Emmett, presented his plan for covering 15,000 to 30,000 Idahoans using state funds only at a cost of $15 million to $30 million a year, or $1,000 per person annually.

Sen. Maryanne Jordan, D-Boise, called on lawmakers to opt for straight Medicaid expansion. Any committee recommendation, Jordan said, “should provide the most economic benefit to the state, and more importantly the most comprehensive solution to the 78,000 Idahoans in the gap.”

The committee will meet again Sept. 28.

Bill Dentzer: 208-377-6438, @IDSBillD

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