The Idaho Senate debated and rejected Medicaid expansion this afternoon, as Senate Democrats pushed the plan in an amendment. “Over the past couple of years we had much discussion about waiting for the presidential election,” said Sen. Maryanne Jordan, D-Boise. “Well, that’s happened. Then the conversation became waiting to see what plan might be rolled out. Well, that’s happened as well. The plan that’s rolled out still retains a Medicaid expansion.”

She said, “The counties are bearing a huge burden. … There’s a tremendous savings to both the counties and the state to go forward with this plan.” She noted that the latest estimates continue to show that 78,000 Idahoans fall into a coverage gap, earning too much to qualify for Medicaid, but too little to be eligible for subsidized coverage through the state’s successful health insurance exchange. “Folks who are caught in the gap … are trapped,” Jordan said. “For a lot of these people, it’s because they’ve got significant health care issues that keep them from working.”

The Democrats’ amendment to SB 1142, Sen. Marv Hagedorn’s $10 million gap coverage bill that would draw on Millennium Fund money to fund some  care for a portion of the gap group, failed on a voice vote, and amendments favored by Hagedorn and Sen. Steven Thayn, R-Emmett, were adopted instead.

Hagedorn said his amendments would accomplish the recommendations of a legislative working group that met over the interim – all but expanding Medicaid, “and it does not cover the entire 78,000 population,” he said. “The objective is to try and bring as many of the chronically ill … into a preventive care program, and a managed care program,” where their needs would be addressed through paying a provider a “fee for value instead of a fee-for-service system.”

Sen. Janie Ward-Engelking, D-Boise,  said, “If we were to use the Millennium Fund money, and we leveraged it with Medicaid expansion, we could leverage the $10 million and bring in $90 million from the expansion – that would be $100 million that we could use to cover this gap population.”

She said, “We’ve debated this so many times and talked about the importance of covering these hard-working Idahoans who in some cases, through no fault of their own, they cannot qualify for insurance.” Under the Democrats’ proposal, she said, “We’ll have $100 million that will really make a difference for this gap population.”

Hagedorn said his $10 million plan would cover about 15,000 of the chronically ill people in the gap population. The amendments also create a pilot project for 250 of the most ill in that group, “to get some data on the success or failures of doing that managed care for that population.”

Sen. Jim Rice, R-Caldwell, said he believed expanding Medicaid would “destroy” the current state insurance exchange, “at a time when it is not clear what the Congress will do. … It changes a lot of things.”