These bad bills could hurt Idaho patients, doctors and taxpayers alike | Opinion

As Idaho lawmakers debate House Bill 850, they are considering repealing Medicaid expansion — a policy Idaho voters approved with 61% support in 2018.

In medicine, a misdiagnosis can be fatal. In government, it just gets expensive.

As a Treasure Valley family physician who treats Medicaid patients every day, I see the real-world consequences of these policy decisions. What I see in the current repeal effort is a shell game.

Around 90,000 Idahoans receive coverage through Medicaid expansion. Supporters of repeal argue the state must cut the program to prioritize services for people with disabilities. But at the same time lawmakers are advancing House Bill 759, which would cut $21.8 million from programs that provide residential habilitation for adults with developmental disabilities.

Several of my patients are nonverbal, rely on feeding tubes or wheelchairs, and require round-the-clock caregiver support. These are not abstract budget entries on a spreadsheet. These are Idahoans whose daily survival depends on those services.

Lawmakers should not claim to be cutting one vulnerable group to help another when both are on the chopping block. Idaho should not be forced to choose between people with disabilities and working families who cannot afford private insurance, simply because legislators returned surplus funds during a strong revenue year which created a deficit the following year.

Supporters of repeal argue Medicaid expansion is too expensive. But they ignore the bill Idaho paid before expansion.

In the years leading up to 2020, Idaho taxpayers spent roughly $60 million annually through the County Indigent Program and the State Catastrophic Health Care Fund. That was entirely state and local money used to pay hospital bills for uninsured patients who had no access to primary care.

Since expansion, that spending has dropped by nearly $40 million according to state reports.

The reason is simple: when people have a primary care doctor, they treat problems early instead of waiting until a minor infection becomes a $30,000 hospital stay.

Before expansion, the emergency room was Idaho’s most expensive “clinic.” Repealing expansion will not make these patients disappear. It will simply return Idaho to the old system, where local property taxpayers pay the entire bill.

Under Medicaid expansion, the federal government covers 90% of the cost. Idaho taxpayers pay roughly ten cents of every dollar. Walking away from that arrangement doesn’t save money. It shifts more of the burden onto Idaho taxpayers.

This repeal effort also comes as the Idaho Department of Health and Welfare has already cut Medicaid reimbursement rates by 4% and eliminated care-coordination payments to primary care doctors.

Medicaid already reimburses providers at the lowest rates in the state. When reimbursement keeps falling, clinics eventually limit how many Medicaid patients they can see — or often stop accepting them entirely. This issue isn’t about physician income. It’s about whether patients can find a doctor willing to treat them.

If HB 850 passes, we won’t simply be taking away insurance cards. We will be weakening the fragile network of physicians willing to care for Idaho’s most vulnerable residents.

Repeal supporters argue that current income limits — about $22,000 for a single adult — create a “benefit cliff” that discourages work. But let’s be honest about the reality facing many Idaho workers. Someone earning $22,000 a year is not choosing between Medicaid and an $80,000 job (median Idaho income). More often, they are choosing between unstable low-wage work without insurance and maintaining access to basic health care.

For many rural hospitals in Idaho, Medicaid expansion revenue has helped keep their doors open. We do not need a hasty repeal of a program that is stabilizing parts of Idaho’s health care system. We need leaders focused on practical reforms instead of political maneuvering.

Idaho voters already made their decision in support of expansion. Lawmakers should respect it.

Dr. Brian Crownover, M.D., FAAFP, is the founder of Treasure Valley Family Medicine, an independent primary care clinic in Meridian ,and a retired U.S. Air Force Medical Corps officer.

This story was originally published March 19, 2026 at 4:00 AM.