BOISE — For more than three hours Friday, people waited for the opportunity to address lawmakers about proposed work restrictions and sideboards on Medicaid expansion.

They were doctors and nurses, medical students, cancer survivors. They were disability advocates and the disabled. They were parents, business representatives, spiritual advisers.

Almost without exception their message was the same: Please don’t do this. Don’t make it harder for Idahoans to get the health care they need.

“We should be asking what is the right thing to do. What is our moral obligation to our fellow human beings?” said the Rev. Sara LaWall, a minister at the Unitarian Universalist Fellowship in Boise.

“As a faith leader, the only answer is that we do whatever we can to ensure that our neighbors have access to the same basic care we do. This is what ‘love thy neighbor’ looks like,” LaWall said. “I hope and pray we will heed that moral call and find the courage to care for our fellow human beings.”

Mark Schlegel, pastor at Hyde Park Mennonite Fellowship and mission coordinator at the Corpus Christi House homeless shelter in Boise, said work requirements would prevent many of the individuals he encounters from getting the treatment they need.

“Each year, I preside at about a dozen (funeral) memorials at the shelter,” he said. “Many of these are preventable. These children of God are worthy of health care. They are worthy of health care. As Idahoans, as children created in the image of God, they are worthy of health care. Funding Medicaid expansion without these work restrictions is one way we can help more people flourish. As people in public service, that is a huge part of our vocation.”

Friday’s House Health and Welfare hearing came four days after legislation was introduced to limit or condition the straight Medicaid expansion plan that voters approved last fall. The bill, which House Republican leaders say has the support of their caucus, directs the Department of Health and Welfare to request four federal waivers that would apply to Medicaid expansion.

The most controversial waiver would add a mandatory work requirement of 30 hours per week. Of the approximately 50 people who testified, it was the primary concern.

Mandatory work restrictions “would cut 6,500 people out of Medicaid expansion,” noted Lauren Necochea, director of Idaho Voices for Children.

Based on studies in other states, she said, most of these individuals would lose their eligibility not because they weren’t working, but because they didn’t fill out all the paperwork. Denying eligibility to 6,500 people would effectively create a second gap population, Necochea said, and cost the state about $1.6 million per year in administrative and higher indigent care costs.

“When you consider the human and fiscal impacts, it’s clear you should reject this bill and implement unmodified Medicaid expansion,” she said.

Fred Birnbaum with the Idaho Freedom Foundation was the only person to testify in favor of the legislation. He suggested medicaid expansion could potentially bankrupt the state.

“I don’t think many people understand the extent to which traditional Medicaid has expanded in the state, and what the implications are,” he said. “In fiscal 1999, Medicaid was a $533 million program. In FY ‘19 it was approximately $2.45 billion, and the appropriation for fiscal 2020 is $2.83 billion. We have to, as responsible citizens, rein in the growth of Medicaid. If we expand Medicaid and don’t put sideboards on it, it’s not going to do that.”

Several speakers, however, suggested there are more effective ways to help people move off Medicaid and reduce costs for taxpayers. For example, Alex LaBeau, president of the Idaho Association of Commerce and Industry, noted that Montana has had “tremendous success” with a voluntary program that gives people access to work and employment training services.

“For those who receive help through their Help-Link program, the average wage increase is $8,712 annually,” he said.

Nearly a dozen doctors, nurses and health care professionals were among those who testified in opposition to the bill Friday. They suggested that providing access to preventative medical care was the best way to put people back to work.

“This bill introduces more bureaucratic inefficiencies in the form of work requirements,” said Andy Wen, a University of Washington medical student who is on a training rotation at the Boise VA Hospital. “The vast majority of people in the coverage gap are already working. This burdens them with additional (paperwork) hoops to prove they’re working. I’ve found that people aren’t looking for free or affordable health care so they can stop working; they’re looking for medical care so they can get to work.”

Susie Pouliot, CEO of the Idaho Medical Association, said her organization opposes any legislation that takes away coverage from eligible individuals, that adds to administrative costs or that would delay implementation of Medicaid expansion.

“In our assessment, this bill clearly violates the first two principles, and potentially violates the third,” she said. “It seems to be out of alignment with widely held Republican values of limited government and the fiscally responsible expenditure of taxpayer dollars. This isn’t the light hand of government in administering the program.”

Other waivers proposed in the bill would:

Limit retroactive coverage of medical costs to 30 days prior to applying for Medicaid, down from 90 days for traditional Medicaid

Give people who earn between 100 percent and 138 percent of the federal poverty level an option to receive subsidized health insurance through the state insurance exchange, rather than switch to Medicaid

And allow private mental health facilities to qualify for Medicaid payments for treating Medicaid-eligible patients.

The fate of the legislation was uncertain Friday, after the committee adjourned without taking action.

Rep. Mike Kingsley, R-Lewiston, said he doesn’t support the measure as written. He thinks that’s the consensus opinion.

“I don’t think it gets out of committee,” he said.

However, the Republican caucus still seems intent on placing some sideboards on expansion, even if this bill isn’t the final solution.

“Everything is still out there,” said Rep. John Vander Woude, R-Nampa, who has been leading the sideboard negotiations. “We’re working on what it might look like. We’re trying to get something that can make it through the House and Senate and get the governor’s signature. We’re trying to get something that’s fiscally and medically responsible.”

Spence may be contacted at or (208) 791-9168.

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