Idaho bill that could repeal Medicaid expansion advances to House, despite negative public testimony

By one vote, the Idaho House Health and Welfare Committee on Wednesday advanced a bill critics said would repeal Medicaid expansion.

House Bill 138, by Rep. Jordan Redman, R-Coeur d’Alene, requires Idaho to enact 11 Medicaid policy changes or repeal Medicaid expansion – a policy that lets more low-income Idahoans be eligible for the health insurance assistance program.

Idaho needs approval from the federal government to implement many of the policy changes – like work requirements, capping expansion enrollment, and kicking people off Medicaid expansion after three years – that Redman’s bill would require.

If any of those policies aren’t in effect by July 2026, the bill would repeal Medicaid expansion, a law passed in 2018 by nearly 61% of Idaho voters.

“Today, you may hear testimony saying that this bill is a sneaky way to repeal Medicaid expansion. And that’s simply not the case,” Redman told the committee as the hearing began. “This bill is taking Medicaid expansion, putting accountability measures in place and cutting waste to make sure that the state is being the best stewards as we can be for taxpayer funds.”

But in an analysis of the bill, Idaho Voices for Children found several of those provisions have either never been attempted or approved, even during President Donald Trump’s first term.

“To me, this is the bullets in the gun to kind of force them a little bit, right?” Redman told the committee in response to a question. “I think without that, I do think it could sit on a desk and not have any attention to it.”

About 89,300 Idahoans are enrolled in Medicaid expansion, according to December figures from the Idaho Department of Health and Welfare.

Idaho House committee rejected similar bill last year

Last year, the same House committee halted a similar Medicaid expansion reform-or-repeal bill by Redman – after wide public opposition that cast the bill as an attempt to repeal Medicaid expansion with more steps.

This year, Redman’s bill was also met with wide opposition in public testimony – from doctors, patients on Medicaid and others – that largely focused on the same point.

But since last year, the committee’s makeup has changed significantly, the Idaho Capital Sun previously reported. Redman said the federal government – under the Trump administration – is likely to approve the sideboards his bill demands.

Dr. Brandon Mickelsen, representing the board of directors for the Idaho Academy of Family Physicians, urged the committee to oppose the bill.

Many rural hospitals in Idaho are at risk of closing due to financial reasons, he said.

“These medical costs won’t go away if you repeal Medicaid expansion,” Mickelsen said. “You will create enormous costs for rural hospitals and local communities.”

Freshman lawmakers largely support advancing the bill

In response to critical questions from committee members about how the bill wouldn’t effectively repeal Medicaid expansion, Redman maintained he believed the federal government would likely approve Idaho’s requests for sideboards through waivers.

He stressed that the bill is intended to reform – not repeal – Medicaid expansion.

Some lawmakers weren’t convinced the bill would avoid repeal.

“This is not a reform bill. This will kill Medicaid expansion” said Rep. Marco Erickson, R-Idaho Falls, the committee’s vice chair. “And those rural clinics will be the number one first places to go.”

But many of the committee’s members who are serving their first year in the Legislature joined Redman and committee Chairman John Vander Woude, R-Nampa, to pass a motion on an 8-7 vote to send the bill to the full House floor, rejecting a motion to hold the bill in committee.

Two freshman lawmakers who supported advancing the bill stressed the bill ought to go before the entire Idaho House of Representatives.

Noting that the committee members were largely new to serving in the Legislature, Rep. Tanya Burgoyne, R-Pocatello, said, “I think it would be irresponsible of us not to turn to the institutional knowledge that is here in the body of the House – that has been here that has a lot more insight than us eight freshmen.”

The Idaho House “is responsible for approving the appropriation for this … expansion for Medicaid as a whole,” said Rep. Lucas Cayler, R-Caldwell.

Dozens of doctors, patients, advocates testified against the bill

Three of the five people who spoke in favor of the bill were conservative think tank representatives. That was also similar to last year’s hearing.

About two dozen people testified against the bill Wednesday. But Egbert said opposition was even wider in written testimony and among people who registered but didn’t testify in Wednesday’s more than two-hour committee hearing.

Dr. Kelly McGrath, a family medicine physician who practices in Orofino, told the committee that at best, the bill would cut off health care access for thousands of Idahoans.

At worst, the bill would shut down Medicaid expansion, he said.

“The patients I see through Medicaid expansion are often experiencing difficult medical conditions, or just living through challenging financial times. For those patients, health coverage is a literal lifeline,” McGrath testified.

McGrath said Idaho Medicaid expansion has let patients access preventive care and screenings that help detect health issues early on, “when treatments are most effective” and “less expensive.”

“Recently, I had a patient tell me, ‘Without Medicaid, I would be dead,’ ” McGrath said. “She was right.”

Sandra Rainey, who lives in Boise, told the committee “it is a blessing” that her 28-year-old daughter – who lives with Rainey and works full time, earning $14.50 an hour – is on Medicaid, along with her daughter’s two kids.

Without Medicaid, Rainey said her daughter would go into debt “every month due to severe asthma issues” along with the cost of medication and physician care.

A quarter of Idaho’s direct care workforce – in low-paid, demanding jobs that Idaho has a shortage of workers for – rely on Medicaid expansion for insurance, Idaho Council on Developmental Disabilities Executive Director Christine Pisani testified.

“If Medicaid expansion is repealed, 25% of the direct care workforce in Medicaid’s home and community based service system would lose their health care coverage due to low wages,” Pisani said. “… This loss would continue to impact the amount of people who work in the direct service field, who are available to support seniors and people with disabilities. We cannot afford to lose any more workers in this field.”

Bill supporters point to rising Idaho Medicaid costs, but reports identify economic ripple effects, savings

Most of the supporters who testified spoke about the need to tamp down rising costs of Idaho Medicaid expansion. The federal government pays 90% of Idaho’s Medicaid expansion costs.

In 2019, before Medicaid expansion, Idaho Medicaid’s total budget was almost $2.5 billion, including $1.6 billion in federal dollars and about $880 million in state dollars. For next fiscal year, which starts in July 2025, the Idaho Department of Health and Welfare requested $5.3 billion – including $3.5 billion in federal funds and $1.8 billion in state funds.

Idaho Freedom Foundation legislative affairs director Fred Birnbaum called the bill “a necessity.”

“A gun is to our head. And this bill, if we don’t do this now, what will we do? Nothing’s been done yet,” Birnbuam said.

Speaking on behalf of the Foundation for Government Accountability Action – a Florida-based conservative think tank that worked with Redman on the bill – Paige Terryberry said the bill “will rescue Idaho’s budget, reprioritize the truly needy and restore faith in Idaho’s institutions.”

Mountain States Policy Center President Chris Cargill said the bill is about adding side rails on Medicaid expansion – not repealing it.

“It’s a mistake to assume that just because a waiver hasn’t been approved in the past, that it won’t be approved in the future,” he testified. “And what has changed, of course, has been the new Trump administration looking to be more innovative and cutting government waste and getting our fiscal house in order.”

Fuhriman, a Republican from Ammon, said he had heard so many different statistics about Idaho Medicaid expansion that he didn’t know what to trust. But Fuhriman pointed to economic impacts from Idaho’s Medicaid expansion.

Estimating that next year, Idaho Medicaid expansion would cost Idaho $130 million, he said that translates to “$65 per capita. But the economic impact of Medicaid … is $750 per capita.”

“I’m a financial planner. That’s a pretty good return on investment,” Fuhriman continued. “We’ve worked hard to reduce taxes. We’ve had three different tax bills this session that we’re looking at, spearheaded by our speaker, to the tune of nearly $400 million. And we want to say that our budget is out of control because of $130 million being spent on Medicaid – that brings in nearly $47 million in total tax revenue.”

Despite rapid population growth, rising costs of living and inflation driving up service costs, an Idaho Fiscal Policy Center report released Tuesday found “Medicaid costs have grown slower than other parts of the state budget.”

Total general fund expenditures in Idaho grew by 39.5% from Idaho’s state fiscal years 2019 to 2024, but Medicaid expenditures grew in that time at roughly half that rate – rising 19.6%, according to the report.

Idaho Medicaid expansion also saves money across other state programs. In Idaho’s fiscal year 2023, state costs for Medicaid expansion were about $73 million, but expansion saved about $78 million that year across other policy areas, like in corrections, drug courts, behavioral health, county indigent funds and state catastrophic health programs.

Last week, an economic analysis by University of Idaho professor Steven Peterson found the federal government’s extra federal funds for Idaho Medicaid expansion – less than $1 billion this fiscal year – generated $1.5 billion in economic output in Idaho, the Sun previously reported. The report also found those extra federal dollars boosted Idaho’s tax revenues by almost $47 million.

Since Idaho’s Medicaid expansion took effect in 2020, Idaho Hospital Association CEO Brian Whitlock testified that the Legislature has “given billions in tax relief,” funded education “at historic levels,” invested in infrastructure at record levels, and stockpiled rainy day funds “to the brim.”

Bonnie Shuster, a Boise resident, also pointed to the Legislature’s tax cuts.

“You say we can’t afford these funds to keep our people healthy. But then propose even bigger tax cuts that mostly help the wealthy,” she said. “Please support health care for all of us.”