BOISE — A bill to add work requirements and put other limits on Medicaid expansion is headed back to the Senate.
The bill originated as a Senate bill that would have made some minor changes to Medicaid expansion such as adding a voluntary work training requirement. However, on Monday the Senate added more restrictions, including mandatory work requirements, bringing it closer to an earlier House bill.
Friday afternoon, the full House took Senate Bill 1204 up, adding several more Republican amendments and rejecting several Democratic ones in a series of mostly party-line votes. Then, the House voted to pass the new bill 49-20, with six Republicans joining all the Democrats to oppose it.
Idaho voters approved Medicaid expansion via ballot initiative last year. Many Republican lawmakers opposed Medicaid expansion and support efforts to limit it. Democrats and Medicaid expansion advocates have been pushing for expansion without any changes. The proposed work requirements have been the most controversial change.
“There is no such thing as freedom without personal responsibility,” said Rep. Julianne Young, R-Blackfoot. “Freedom without responsibility is dependency, and those who are dependent cannot be free.”
Rep. Barbara Ehardt, R-Idaho Falls, said she comes from a blue-collar background and has worked four jobs at once before. She said she doesn’t mind paying taxes to help children, the disabled, the elderly and others who need help, but that able-bodied people should work.
“I am not willing, nor do I think it is fair, that I should have to be asked to continue to work four jobs, maybe five jobs, to continue to pay for those who are not working,” she said.
Rep. Bryan Zollinger, R-Idaho Falls, said changes to the work requirements making it easier to re-enroll will help the state avoid the legal problems other states have had.
“We’re taking people’s concerns into account with this amendment. … I believe this language gets us around any potential lawsuit like we’ve seen in Kentucky and Arkansas,” he said.
A federal court ruled last week that work requirements in those two states were unconstitutional. However, the Trump administration supports work requirements, and more litigation seems likely before the question is settled.
“Kicking people off health coverage goes against the central tenet of Medicaid,” said Liz Woodruff, Assistant Director of Idaho Voices for Children. “By law, a state cannot make work a condition of accessing health coverage.”
Assistant Minority Leader Rep. Ilana Rubel, D-Boise, said the requirements would mean the state will spend $2.8 million to “hire 13 people to go chase around poor people and kick them off Medicaid expansion.”
“This will recreate a gap,” she said. “There will be thousands of people who can’t meet their requirements and will be uninsured.”
After Friday’s changes, the bill would:
- Require expansion beneficiaries to work, go to school, volunteer or get job training at least 20 hours a week. Some groups such as people unable to work, people under 19 or over 59, or the caretaker of a child under 18 would be exempt. Those who don’t comply would be ineligible to re-enroll for two months, although if they show they are in compliance they could re-enroll sooner.
- Insure people making between 100 and 138 percent of the poverty level on the Your Health Idaho state exchange, although they could opt to enroll in Medicaid instead.
- Require patients to get a referral from their primary care doctor to seek outside family planning services.
- End expansion if the Affordable Care Act is declared unconstitutional.
- Call on the Legislature to review expansion in January 2023 and discuss whether to continue it.
The first three would require waivers from the federal Centers for Medicare and Medicaid Services.
The Democrats offered several changes that were shot down. The one that drew the most debate, offered by Rep. John Gannon, D-Boise, would have let the children of parents believe in faith healing sign up for Medicaid.
Gannon has been pushing for several years to change Idaho law, which exempts faith-healing parents from child neglect or homicide charges if their children are injured or die from treatable illnesses. He said his proposal could help older children who want health care, or let an older sibling take action on behalf of a sick younger one.
“The problem of parents who willfully, intentionally refuse medical attention for their kids is not going to go away,” Gannon said. “What you have before you today is a partial solution, and it’s a really neat solution.”
The House also shot down amendments to change the bill back to the original Senate bill and to exempt gay and transgender people who can’t find a job due to discrimination from the work requirements. It never considered an amendment that would have ensured married children are eligible for Medicaid.
Rep. Melissa Wintrow, D-Boise, who sponsored a bill the House voted down earlier this year to ban marriage of children under 16, said she worried about what would happen if a married teenager’s adult spouse were to lose Medicaid eligibility. While children are normally eligible for Medicaid, married ones are legally emancipated.
“It wasn’t really clear what would happen to the minor child,” she said.
The Idaho House follows an unusual procedure for voting on amendments — there is a voice vote, then if three lawmakers request a “division” lawmakers stand or sit to show their support or opposition. “Divisions” are not recorded in the official journal, and on Friday Majority Leader Rep. Mike Moyle, R-Star, and Assistant Majority Leader Rep. Jason Monks, R-Nampa, told the crowd in the gallery not to take photos or videos of the votes.
“The majority is afraid of being held accountable,” Minority Leader Rep. Mat Erpelding, D-Boise, said after the vote. “They do not want Idaho voters to know that their opposition to Medicaid remains, even in the face of a popular vote. With or without photos, Idahoans will remember the day that the House Republicans passed expensive and impractical amendments without the consent of the voters.”
People testifying at the public hearings that have been held have almost unanimously opposed work requirements. However, some Republicans didn’t think this reflects the views of the state as a whole.
“Sometimes I think we forget we are in the heart of Boise and no disrespect to my colleagues in the … Boise area but the demographics are different here,” Zollinger said. “If the state Capitol was located in St. Anthony, Idaho or Oakley, Idaho we would have a different crowd at the Capitol every day.”
Medicaid expansion is one of the last major issues lawmakers need to deal with before adjourning for the year. The Senate may vote Friday on whether to agree with the House’s changes.
Idaho Press Boise bureau chief Betsy Russell contributed.