BOISE — A consensus bill that restricts eligibility for the state/county indigent health care program earned a favorable recommendation from the Idaho House Health and Welfare Committee Thursday.
House Bill 316 also shifts financial responsibility for public health districts from the state to the counties.
The legislation is expected to save the state about $9.8 million per year. The net fiscal impact for counties would be neutral to slightly positive; they’d save an estimated $12 million in indigent care costs, while picking up the $9.8 million tab for public health services.
The health districts and Idaho Association of Counties both support the measure. The Idaho Hospital Association — whose members will likely face higher charity care costs if the bill is approved — hasn’t taken a position on it.
The indigent care program serves as the payer of last resort for people who can’t otherwise afford medical treatment. Counties pay the first $11,000 of someone’s bill, and the state covers the remainder.
HB 316 doesn’t eliminate the program, but it would severely limit eligibility. Anyone who qualifies for Medicaid or for subsidized health insurance through the state exchange would no longer qualify.
“The idea behind this is that every Idahoan, whether you qualify for Medicaid or you qualify for a subsidy on the insurance exchange, has access to affordable health insurance,” said Seth Grigg, executive director of the Idaho Association of Counties. “So in essence it becomes a lifestyle decision. If you choose not to purchase subsidized insurance off the exchange, you’re making that decision. The question then arises, is it fair for taxpayers to pay for that lifestyle decision?”
If the legislation is approved, hospitals will still have to provide medical treatment for uninsured patients. House Minority Leader Ilana Rubel, D-Boise, said that potentially leaves hospitals “holding the bag” for costs that were previously covered by the indigent program.
Brian Whitlock, president of the Idaho Hospital Association, agreed with that assessment, although it’s unclear at this point how significant a financial hit that could be.
“Medicaid expansion will cover some of the uninsured costs we’ve traditionally seen,” he said. “But there will still be some folks who didn’t buy insurance who will end up in hospitals. We won’t get (the payment) we would have gotten through the indigent program. That will have an impact. Will it be enough that hospitals will have to close? I can’t say that it will, but there will be a financial impact.”
Whitlock also highlighted potential problems with the emergency clause in HB 316. It would implement the eligibility changes as soon as the governor signs the bill — but the enrollment period to buy subsidized insurance through the state exchange doesn’t open until November, and coverage wouldn’t start until January.
“If the state is going to ask every Idahoan to be responsible for their own health care coverage, it should at least give them a chance to get that coverage,” he said.
Rubel proposed amending the bill to address that concern, but the committee chose instead to send it to the House floor with a favorable recommendation.
“The fiscal impact would change considerably if we change the implementation date,” said Rep. John Vander Woude, R-Nampa, who sponsored the bill. “Given the time frame where we’re at now (in the session), it’s critical we get this bill through the floor and over to the Senate. If any changes are needed, they can be made on that side.”
Spence may be contacted at bspence@lmtribune.com or (208)-791-9168.
