Otter could be key to finding health coverage for ‘gap’ population

Legislators will never alleviate the suffering of 78,000 working poor Idaho adults by extending Medicaid coverage to them.

If you doubt that, then you weren't listening to the members of an interim legislative working group assigned to look into the issue.

Among them:

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

▪  Rep. Judy Boyle, R-Midvale — “I am not for Medicaid expansion. I think we've heard of some other options. I think we can come up with a really good solution that fits Idaho.”

▪ Sen. Steve Thayne, R-Emmett — “The reduction of overall medical costs, I don't think it can be done within the structure of federal rules - that's my big concern.”

▪ Sen. Marv Hagedorn, R-Meridian — “This is a big elephant we're trying to eat, and the way I've always been told is you do it one bite at a time.”

That's four out of eight Republicans on a panel assigned to break the logjam that has stymied health care coverage for adults who make too little to qualify for subsidized private health insurance under Obamacare.

Even if they changed their minds, what about the Bedke Rule?

House Speaker Scott Bedke has refused to pass any major measure unless he can do it without Democratic help — so he needs 36 out of the 56 House GOP members.

And if by some miracle Bedke either suspends his rule or the rank-and-file House GOP has a change of heart, there's still the calendar.

Assume Republican lawmakers remain fixated on coming up with a modified program. That requires the 2017 Legislature to authorize the state to negotiate a waiver from the standard Medicaid program.

Whatever agreement the state and the Centers for Medicare and Medicaid Services make must be approved by the Legislature. Such a vote would occur just on the eve of the 2018 closed Republican primary election, where the partisan base may retaliate against any lawmaker who supports the Medicaid deal.

Hence, people such as former Division of Financial Management Director Marty Peterson (Note: Peterson is a member of the Idaho Statesman Editorial Board) are calling on Idaho Gov. C.L. “Butch” Otter to act on his own.

Otter's no stranger to issuing health-care related executive orders. In April 2011, he actually used that authority to block implementation of Obamacare. Five years later, he used it to allow up to 25 children to secure an experimental, marijuana-based drug to treat severe seizures.

By using that same authority to expand Medicaid, Otter would be following in the footsteps of governors in states such as Alaska, Kentucky, Louisiana, Arizona and Iowa.

Spending state money on Medicaid expansion still takes legislative approval. But the governor has some good cards to play.

For instance, the package Sen. Dan Schmidt, D-Moscow, proposed earlier this year required the state to spend about $12.2 million to match $460 million in federal Medicaid funds. On the other hand, Medicaid expansion would free the state from spending about $32.5 million on such things as catastrophic health care for medically indigent people and public health programs.

So Otter would be asking lawmakers to pass a budget cut.

Besides, lawmakers can reject a Medicaid expansion bill and still go home. But lawmakers can't leave Boise without passing a budget.

That gives the governor real leverage. As long as Otter has 12 state senators to sustain his veto of any budget that excludes Medicaid expansion, he can keep lawmakers in session until Independence Day.

Otter shies away from confrontations with the Legislature. But if this governor fails to act soon, nothing is going to change until his successor takes office in 2019.