Some Idaho lawmakers remain unconvinced about Medicaid expansion

BOISE – Some Idaho lawmakers are still reluctant to accept federal Medicaid expansion funds to close the state’s health coverage gap, after months of hearings, overwhelmingly positive public comments and stacks of statistics showing Idaho would save millions of dollars by doing so.

“I am not for Medicaid expansion,” Judy Boyle, a Republican state representative from Midvale, said as an all-day hearing wrapped up Monday. “I think we can come up with a really good solution that fits Idaho.”

But state Sen. Jim Guthrie, R-McCammon, said Idaho needs to act. Public opinion in favor of Medicaid expansion is “overwhelming,” he said, as is economic data. “To be honest with you, I’m having to set aside some political and philosophical biases that I have,” he said.

Thirty-one states, including Washington, have expanded their Medicaid programs under the national Affordable Care Act, a step the U.S. Supreme Court made optional for states. Idaho is not among them, but it’s been debating the question for the past four years.

The state’s current Medicaid program is so restrictive that few low-income adults qualify, but those who don’t can’t get subsidized coverage through Idaho’s health insurance exchange unless they make at least 100 percent of the federal poverty level.

That’s left 78,000 people in a coverage gap, with no help to obtain health coverage they can’t afford. At a legislative hearing in February, Dr. Kenneth Krell, director of critical care at Eastern Idaho Regional Medical Center in Idaho Falls, estimated that more than 300 Idahoans a year are dying prematurely as a result.

And Idaho spends tens of millions of dollars each year on a much-criticized program in which state and local tax receipts pay off the catastrophic medical bills of patients who can’t pay. If Idaho expanded Medicaid, that program would largely go away.

Sen. Maryanne Jordan, D-Boise, called for full and immediate Medicaid expansion – which a national consultant told the lawmakers on Monday they could do right now, with no need for a federal approval.

“That meets the immediate need,” Jordan said. “We’re already being taxed to pay for Medicaid – the money just isn’t coming back to Idaho. It’s going to other states. Four years of inaction have left millions of dollars on the table that could be growing the Idaho economy.”

Other legislators objected to Medicaid’s status as a third-party payer system; the “creep of federal rules and federal involvement” in states’ affairs; and one, Sen. Patti Anne Lodge, a Republican representing Huston, said some of the 78,000 people in the coverage gap “could pay for their health insurance if they just worked a little more.”

Since the panel’s last meeting Aug. 11, it has received 82 public comments, none opposed to covering the people in the gap. The panel will meet again Sept. 28.