Committee passes bill to restrict Medicaid

BOISE — The House Health and Welfare Committee on Wednesday narrowly approved a bill placing strict conditions on Medicaid expansion, under the threat of full repeal, after around two hours of overwhelmingly negative testimony.

Members voted 8-7 to send House Bill 138 to the floor with a recommendation that it pass, with several who opposed it saying they were concerned about the bill’s “trigger” of a full repeal of the expansion program if the Idaho Department of Health and Welfare could not receive all 11 waivers required from the federal government.

Idaho voters in 2018 voted to expand Medicaid eligibility to those who fell in the “coverage gap” by not qualifying for traditional Medicaid and not qualifying for health insurance through the state exchange. As of Feb. 6, more than 80,000 people were enrolled in the Medicaid expansion program, according to the health department website.

The conditions in the bill require the health agency to seek federal waivers to get permission to implement changes to the state’s Medicaid program, including adding work requirements, adding an enrollment cap, limiting hospital presumptive coverage and adding a three-year lifetime limit on care in the program.

Bill sponsor Rep. Jordan Redman, R-Coeur d’Alene, introduced a nearly identical bill last session, which died in committee on an 8-5 vote, the Idaho Press reported at the time.

Rep. Josh Wheeler, R-Ammon, asked Redman why he included the automatic full repeal of the expansion program if the Department of Health and Welfare was not able to obtain all 11 waivers to the program from the federal government. Wheeler said he would rather the conditions be subject to legislative review.

Redman responded that he thought the threat of repeal would incentivize the federal Centers for Medicare & Medicaid Services, which must approve changes to state Medicaid programs.

“To me, this is the bullets in the gun to kind of force them a little bit,” Redman said to Wheeler. “I think without that, it could sit on a desk and not have any attention to it.”

Redman later apologized for using the phrase “bullets in the gun.”

Wheeler responded, “What I fear that we have done with the way we currently have the language written, is we’re telling those D.C. bureaucrats they can decide, and we are not putting anything on the line for them. We are putting everything on the line for us and our constituents. … we got the gun pointed at ourselves, not at the bureaucrats.”

Members asked Redman questions about the bill for nearly an hour before testimony began.

Wheeler made a motion to table the bill before any testimony based on the concerns he had.

Around 30 people spoke at Wednesday’s hearing, with five in favor and the rest in opposition.

Several of those who opposed it said that leaving thousands of people without insurance would have higher costs to the state, counties and health systems due to delays in preventative care. Those who supported the bill said they wanted to rein in costs of Medicaid and encourage people to work.

Committee members and testifiers said the bill might as well be a guaranteed repeal of expansion if it passes because of the difficulty in obtaining the required waivers.

Redman has said he feels confident the waivers will go through based on the priorities of President Donald Trump.

Hillarie Hagen of Idaho Voices for Children noted that other states have attempted to seek similar waivers, such as implementing work requirements, enrollment caps and lifetime benefit limits, and were rejected under the previous Trump administration. She said although the president has signaled he would favor some of the proposed restrictions, current federal laws and rules do not allow many of them.

Dr. Kelly McGrath, a family medicine physician from Orofino, said the patients he sees who are enrolled in the program are “often experiencing difficult medical conditions or just living through challenging financial times.”

“For those patients, health coverage is a lifeline,” McGrath said.

He also said the expansion of coverage helps “strengthen rural economies.”

“Families struggling with medical debt are less likely to be able to invest in businesses, make purchases or participate in the local economy, which are key drivers of rural prosperity to keep our communities healthy and vibrant,” he said.

Fred Birnbaum, director of legislative affairs at the conservative-think tank the Idaho Freedom Freedom Foundation, spoke in favor of the bill.

He highlighted that although around 90% of the Medicaid funds are paid for by the federal government, those were “borrowed dollars,” because of the federal government’s debt. Chris Cargill, of the conservative Mountain States Policy Center, spoke in favor of the bill for similar reasons.

He also argued that the new Trump administration may be more likely to grant the waivers this time around.

“I think 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,” Cargill said.

Jennifer Johnson said she’s a single mother of twin boys and a Medicaid expansion recipient. Both her sons require significant medical attention, one for a congenital heart defect and the other for a developmental disability.

“Medicaid expansion ensures my children get therapies, medication and medical care they need to stay and live and to be kids learning to be productive members of society,” Johnson said. “Medicaid expansion allows me the opportunity to stay healthy, to work, to provide service to the community and to contribute to Idaho’s economy.”

She said she would not be able to afford private health insurance, but she earns too much to qualify for traditional Medicaid coverage.

“If this bill passes, my family will lose our current Medicaid coverage, and I will be left back in that same gap,” she said.

Christine Pisani, executive director for the Idaho Council on Developmental Disabilities, said the state agency opposed the bill because the work requirements proposed — which include an exemption for care givers of children younger than 6 — would not exempt people caring for their aging parents. The bill would also likely remove health care from much of Idaho’s direct care workforce, who provide in-home care.

Mark Johnson, a local resident, said he supported the bill because he “worked for 45 years to date and paid my way the entire way.”

“I found out there’s 140,000 able-bodied people of working age, they’re on Medicaid expansion, and that’s simply offensive to guys like me,” he said, likely referring to the number of people who were in the program in 2023, during the public health emergency when the state was not allowed to un-enroll people.

The number has since dropped after the end of the emergency, when eligibility was re-determined by the department.

There were multiple committee members who said they supported the idea of pursuing the waivers but did not want an automatic repeal of the expansion program if they couldn’t be sought.

“I know we want to say it’s not a repeal bill, but it — in essence because I don’t believe we can get these waivers — is, ” Rep. Ben Fuhriman, R-Shelley, said. “We’re going to see our property taxes go up. That money has to come from somewhere.”

Several members also noted that the bill would not restore funds that were used before Medicaid expansion to pay indigent medical costs.

Rep. Dori Healey, R-Boise, said she didn’t want to place the future of the program with a federal agency.

“I’ve never seen so much faith placed in Washington, D.C.,” Healey said. “I would love to believe that our pressure will force the federal government to accept our waivers, but I remain really skeptical.”

Rep. Tanya Burgoyne, R-Pocatello, said that as a new member, and with so many new members on the committee, she felt it was best to send the bill to the full House for debate.

Rep. Lori McCann, R-Lewiston, highlighted that the committee is tasked with taking testimony and information and deciding the fate of a bill.

“We represent the people, and if you look at your districts, every one of our districts has substantial problems that will be much more evident if we move forward with this,” McCann said.

Rep. Megan Egbert, D-Boise, said she felt Idahoans had decisively spoken on the issue, both by voting to approve expansion in 2018 and the overwhelming testimony. She said the submitted written testimony had 115 who opposed the bill and two in support, and that 150 people who signed in at the hearing opposed it and six supported it.

“The people in Idaho have spoken loudly and clearly on this issue, and I hope this committee that was elected by those people will take it to heart,” Egbert said.

A motion to hold the bill in committee died in a 7-8 vote. The committee then voted 8-7 to send the bill to the full House.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.