Two bills to expand Medicaid in Idaho were introduced in the Idaho Senate on Friday, both as personal bills sponsored by Sen. Dan Schmidt, D-Moscow, a physician; you can read my full story here at spokesman.com.

“I’ve been working for years to get Republican support, and can’t, so what the heck,” Schmidt said. “At least it’s written down. People can look at the numbers, look at the proposals. They’ll be public record. They can compare.”

Most Idaho legislation requires a committee vote even to be introduced, assigned a bill number and printed as a bill, let alone to pass. But individual lawmakers can propose personal bills without committee votes in the early weeks of each year’s legislative session; Schmidt’s two bills were filed on the final day that’s allowed this year.

“The governor’s bill is going to be out there and it’ll have numbers, and people can look at that,” said Schmidt, referring to Idaho Gov. Butch Otter’s proposal for a state-funded $30 million “Primary Care Access Program,” which would provide some limited primary and preventive care to the 78,000 people who fall into a coverage gap in Idaho – they don’t qualify for Medicaid, because the state hasn’t expanded it; and they don’t make enough to qualify for subsidized health plans through the state insurance exchange.

Medicaid expansion, an option for states under the federal Affordable Care Act, would serve that same gap population, by providing them with full health insurance. Instead of costing the state $30 million a year, it would save state taxpayers millions, because the federal government would cover nearly all its costs, and the state would no longer need to spend millions on a catastrophic care program for people with unpaid medical bills.

Otter convened several task forces to study the issue for the past three years, and they all recommended expanding Medicaid. But state lawmakers who want no part of Obamacare have been unwilling to consider the move.

In a guest opinion sent out to Idaho newspapers this week, Otter wrote, “The fact is that the PCAP option – or something very much like it – is all that we can reasonably hope to achieve right now in the context of Idaho’s political environment.”

Schmidt said, “I think the majority party is trying to portray that there aren’t some choices, and that’s how the governor has framed this – that this is his only choice. And I just disagree.”

Schmidt’s two bills include one that would enact the “Healthy Idaho Plan,” a proposal from Otter’s latest task force that would expand Medicaid for those who make up to 100 percent of the federal poverty level, then use the federal Medicaid expansion funds to purchase private insurance, through the state exchange, for those who make up to 138 percent of poverty.

Currently, Idaho’s Medicaid program doesn’t cover non-disabled, childless adults at all. Those with children only qualify if they earn 20 percent of the federal poverty level or less.

People can purchase insurance plans on the Your Health Idaho insurance exchange if they earn 100 percent of the poverty level or more, and most qualify for federal tax credits to help offset the cost. The Healthy Idaho plan “makes it more affordable,” Schmidt said, further subsidizing premiums for the lowest-income purchasers who qualify with the additional expansion funds. Doing that would require a waiver from federal officials; Arkansas is one state that has gone that route.

Last year, 54,000 Idahoans applied for coverage through the exchange, but were turned away because their incomes were too low to qualify.

Schmidt’s other bill would follow the recommendation of Otter’s first task force, expanding Medicaid to the full extent allowed by law – to adults earning up to 138 percent of poverty.

“That will save Idahoans the most money,” Schmidt said. “It’ll have the most impact on the general fund.”

Schmidt said the latest estimates show the Healthy Idaho Plan would save Idaho $28.4 million next year.

The full-expansion option would save $44.3 million.

Schmidt said this is the first time in his six years in the Senate that he’s filed a personal bill.

“When I first got elected, my goal was to work with the majority party, and talk about policy issues and try to foster a healthy discussion for moving Idaho forward,” he said.

Schmidt has made his mark on the Legislature’s joint budget committee by working closely with some of the panel’s most conservative GOP members on compromise funding proposals for the state’s health and human services programs.  “And I didn’t think personal bills were necessarily a way to get that discussion going,” he said.

 “But since the governor’s starting his dialogue with his bill, and I’m sure his is going to get printed, I thought OK – let’s get this one printed, and maybe somebody will look at it,” Schmidt said.

“I’m not giving up,” he said. “I still believe people can, and do, even in this body, change their minds pretty quickly.”

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