You may not want to hold your breath waiting for a Medicaid Expansion solution. But you may want to hold your nose.
The bipartisan working group Idaho Speaker of the House Scott Bedke proposes is likely to be yet another stall tactic by the Republicans in the House. The House Republicans had an opportunity last session with a bill already passed by the Senate, which would have directed Health and Welfare Secretary Richard Armstrong to apply for a federal waiver for Medicaid expansion, coming back in a year to the entire Legislature. The one-year delay before legislative consideration was a disappointment, but this was a start.
How can you explain the last minute machinations to kill the bill authorizing a waiver application, when the House had already approved the funding for the bill the day earlier in a 40-29 vote. For three hours on the last morning of the session, House Republican leaders Bedke, Majority Leader Mike Moyle and Assistant Majority Leader Brent Crane drew those votes back in line, and the enabling legislation was defeated on a straight party line vote.
The House rules by the “Bedke Rule,” a cynical, undemocratic unwritten rule that says no bill will come to the floor that needs Democratic support to pass, a guarantee there will be no bipartisan actions. So why would anyone believe Bedke that he wants to find a way forward when he killed the only shot we had? Imperfect as it was, it was a way forward.
Even if the Bedke working group came up with a viable solution (which would have to look something like the Healthy Idaho bill) the application for waiver couldn’t occur until the next legislative session and approval until the year after that. It could be 2020 before final enactment.
So what can we do? First, we can elect new legislators. But with the Idaho Republican primary process, controlled by people such as Stephen Yates, chairman of the Idaho Republican Party, and Doyle Beck, Bonneville County Republican chair, only a fringe element of the party is allowed to run. Maybe that can change.
Hospitals can help by submitting all the indigent claims they have to the county and CAT fund. They haven’t been, and the counties are happy saving $28 million from added coverage through the exchange.
We could pressure Gov. Butch Otter to authorize Armstrong to apply for a Medicaid waiver. Otter hesitated during the debate when asked if he might unilaterally apply, but in his news conference made clear he would not seek a waiver without legislative authority.
Or we can consider a voter-ballot initiative. It won’t be easy. To ensure they won’t have a repeat of the Luna law repeals, the Legislature has rigged the process to make a ballot initiative more formidable. But it can be done. It appears the people have to find an alternative because the Legislature has consistently failed and refused to act. The 61 percent of Idaho voters who favor Medicaid expansion may have to take control to get this done.
Kenneth Krell, M.D., is the medical director of critical care at Eastern Idaho Regional Medical Center in Idaho Falls. This is his opinion and does not necessarily represent the view of EIRMC.