Idaho sets Medicaid expansion hearing

BOISE - The Idaho Legislature will hold its first-ever hearing on a Medicaid expansion bill next week, giving the public an opportunity to weigh in on one of the most politically contentious issues facing the state.

Senate Health and Welfare Committee Chairman Lee Heider, R-Twin Falls, has scheduled a hearing Tuesday on a personal bill introduced by Sen. Dan Schmidt, D-Moscow.

Expanding Medicaid eligibility to cover everyone who earns less than 138 percent of the federal poverty level was a central component of the Affordable Care Act. It offered states a chance to extend health care coverage to millions of uninsured Americans.

Idaho has refused to approve the expansion, however, as have most states with Republican governors and legislatures. Lawmakers here are concerned the promised federal funding will ultimately disappear, leaving the state to pick up the burden. They're also reluctant to increase public reliance on a government program.

Regardless of the political ramifications, Heider indicated his decision to hold a hearing on the issue was a tribute to Schmidt and the credibility he's developed with his colleagues.

"We have a member of this committee who has a plan and who's gone to the trouble of writing a bill," he said Wednesday. "Maybe it will be a proposal we all like and it will move forward."

Schmidt has worked on this issue for years, encouraging lawmakers in a non-confrontational way to at least talk about Idaho's health care system and to look for ways to improve it.

"I believe I've gotten some respect over time," he said. "In my heart of hearts, I don't think the committee will pass it, but I'm very thankful for the opportunity."

The estimated cost of the bill is $12.2 million in fiscal 2017. That would be offset by an estimated $32.5 million in state savings, with Idaho counties saving another $23.2 million. In both cases the savings stem largely from eliminating the catastrophic health care program, which covers medical costs for people who can't otherwise afford treatment.

"The purpose of this legislation is to provide medical care for approximately 78,000 Idahoans, most of whom are employed full time but earn too little to obtain (subsidized) health insurance" through the state insurance exchange, according to the bill. "This is expected to have a positive impact on the health and productivity of our citizens by increasing access to health care."

If lawmakers are still unwilling to approve the full Medicaid expansion, Schmidt introduced a companion bill that would provide managed Medicaid for people who earn less than 100 percent of federal poverty, while people earning 100 to 138 percent would receive private insurance through the state exchange, with the premiums being covered by state and federal funds.

A hearing on that measure is also scheduled for Tuesday. It's projected cost is $30.3 million, offset by the same state and county savings.

Senate Majority Leader Bart Davis, R-Idaho Falls, said he was unaware that a hearing had been scheduled on a Medicaid expansion bill. He also indicated it was unusual that a hearing on an issue as politically sensitive as this would be scheduled without his knowledge.

"I will be asking about it," he said.

When asked if he had any concerns, Davis said only that he had "questions about what's contemplated."

Heider, who is well aware of the political nature of this issue, noted that once the committee holds the hearing, committee members will "have all the options available to them," including killing the bill outright, recommending that it be approved or recommending that it be amended.

"Frankly, I think that's the best resolution," he said. "We hear the bill and whatever the outcome is, that's the outcome. I don't have a problem with that."

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Spence may be contacted at bspence@lmtribune.com or (208) 791-9168.