BOISE — About 50 people testified at a hearing Friday on a proposal to add some restrictions to Medicaid expansion, and all but two urged lawmakers unambiguously not to do it.

“The reality is we pay for everyone’s health care one way or another,” said Alex LaBeau, head of the Idaho Association of Commerce and Industry. “The question is how to do it.”

LaBeau said adding work requirements to Medicaid expansion eligibility would just lead to more uncompensated health care costs for people who get kicked off Medicaid.

Several people pointed to Arkansas, the only state enforcing work requirements now, as an example of what not to do, saying people have lost coverage there who were working but had trouble with the reporting requirements. A few pointed to Montana, which has a voluntary work referral program for Medicaid recipients rather than a requirement, as an example to emulate.

“My major concern with this bill is work requirements will cost taxpayers millions of dollars ... and will take coverage way from even eligible people,” said Medicaid expansion advocate Sam Sandmire. “The Department of Health and Welfare has indicated that this will cause a second ‘gap.’”

Many Republican lawmakers opposed Medicaid expansion, and they have been saying ever since voters approved it in November that some restrictions are necessary to make sure costs don’t get out of hand.

“We’re just trying to ensure we’re as responsible as possible with taxpayer dollars, and that’s our duty as a Legislature,” Majority Caucus Chairwoman Rep. Megan Blanksma, R-Hammett, said at a news conference Friday.

Democrats and Medicaid expansion advocates have been pushing for expansion without any additional restrictions, arguing that’s what voters want. More than 50 organizations, from the medical and health care industries to educational and charitable groups to advocates for people with disabilities, have signed onto a letter opposing the bill, and some of them testified at Friday’s hearings

“It’s deeply troubling that House majority leadership believes the voters do not understand what they voted for,” said Minority Leader Rep. Mat Erpelding, D-Boise. “They devalue the voter, to justify the fact that they could care less about health care coverage for hardworking Idahoans. And they secretly hashed out another ‘we know better’ bill in some back room.”

The committee heard about two-and-a-half hours of testimony Friday. No vote on the bill has been scheduled and chairman Rep. Fred Wood, R-Burley, said he isn’t sure when he will schedule one. The committee isn’t meeting Monday.

The bill, which is being sponsored by Rep. John Vander Woude, R-Nampa, would require Medicaid expansion beneficiaries to comply with a work requirement modeled on the existing one for food stamps. It would ask for several other federal waivers, including one to give people making between 100 and 138 percent of the poverty level the option of getting private insurance through the Your Health Idaho state exchange instead of Medicaid. It also would end Medicaid expansion if the share of the cost covered by the federal government dips below 90 percent.

Most of the testimony Friday was in opposition to the work requirements, although a couple of people also objected to a provision requiring lawmakers to review the program in 2023, arguing the full savings from expansion won’t have been realized by then. A few people praised the part of the bill requesting an “IMD” (institutes for mental diseases) waiver, which would let the state spend Medicaid funds on some institutional behavioral health and substance abuse treatment that wouldn’t be covered otherwise.

Vander Woude and Blanksma said the proposal could change, as there are many opinions within the Republican caucus as to what restrictions should be put on Medicaid expansion. Whatever happens, they said the bill advanced the discussion.

“It’s a fluid situation, and that’s why we (wanted) public input,” Blanksma said.

Reporter Nathan Brown can be reached at 208-542-6757. Follow him on Twitter: @NateBrownNews.

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