BOISE — After another day and another hearing, the fate of Medicaid expansion in Idaho is still in limbo.
The Senate Health and Welfare Committee voted 7-2 to hold in committee a House bill that would create a work requirement for Medicaid expansion beneficiaries — after lawmakers found out during the hearing that a federal judge had just struck down Medicaid work requirements in Kentucky and Arkansas.
Meanwhile, a Senate bill that would create a voluntary job training requirement for Medicaid expansion beneficiaries is still in that chamber’s amending order and could come up soon. The Medicaid budget for 2019-2020 is still being held in the full House. And Gov. Brad Little has said he won’t let lawmakers adjourn for the year until Medicaid expansion and funding is resolved.
Which bill advances, and what it would look like, could come down to negotiations between the House, where many Republican members want stricter limits on Medicaid expansion, and the Senate. Work requirements had been a major demand for many House members, although it remains to be seen how Wednesday’s rulings in the Arkansas and Kentucky cases will affect either the negotiations or what the state can legally do.
Senate Committee Chairman Fred Martin, R-Boise, who is sponsoring the Senate bill, said it is possible House Bill 277 could reemerge from his committee and be sent to the Senate for amendments, if he gets a sense later about what kind of changes lawmakers want.
“I’m sure there will be some reading and studying and deciding,” Martin said.
Which bill moves forward could come down to some gamesmanship between the two chambers. Martin said if his Senate Bill 1204 heads to the House, its members would have the opportunity to amend it. However, if the Senate amends House Bill 277, the House would just have the opportunity to approve or reject the amendments. Another scenario, although one Martin said he would like to avoid, would be both bills passing and heading to Little’s desk. Another would be to adopt unmodified Medicaid expansion, although many House Republicans, in particular, oppose this.
The House bill would apply for a federal waiver to create a 20-hour-a-week work, job training or volunteering requirement for Medicaid expansion recipients and several other waivers, including one to cover people making from 100 to 138 percent of the poverty level on the Your Health Idaho state exchange rather than Medicaid. Sponsor Rep. John Vander Woude, R-Nampa, pointed to states such as Oregon, where expansion has cost far more than projected, as a cautionary tale.
“The intention of this bill was to at least get some control over the costs so we as a state don’t end up in those same situations,” Vander Woude said.
Wednesday’s hearing started off like the House hearing on the same bill. Idaho Freedom Foundation Vice President Fred Birnbaum testified in favor of the bill and everyone else was against it, one major worry being that covering fewer people would lead to higher costs for hospitals and taxpayers.
“This particular bill creates unreimbursed care, pure and simple,” said Idaho Association of Commerce and Industry President Alex LeBeau, who urged lawmakers to support a voluntary work training program instead.
As Bingham Memorial Hospital lobbyist David Lehman walked up to the podium, he said a federal judge had just struck down the work rules in Kentucky and Arkansas.
“We’ve argued about what the best solution is for the policy in Idaho, based on what we think is best for Idaho,” Lehman said. “I think now the new calculus has to be what is legal in Idaho.”
There was a bit of surprise in the room as people looked at their phones to find out what had happened.
“Oh yeah, I could see the good representative (Vander Woude), he wasn’t smiling when that was announced,” Martin said. “But I’m not sure if that changed the vote. I think it solidified the vote.”
As of right after the hearing, Vander Woude hadn’t had time to research the Kentucky and Arkansas rulings. He said the requirements there might have been crafted differently than his proposal, pointing to the thousands of people who were kicked off Medicaid in Arkansas. Vander Woude’s proposal contains numerous exemptions to the work requirements and he has said he wouldn’t want them to be too burdensome.
“I haven’t read the judge’s decision; I don’t know where that goes,” Vander Woude said in his closing comments. “I realize, Mr. Chairman and members of the committee, that this bill may not go anywhere, and I sense that from ... the committee. I believe that there are a lot of things in this bill that we do need to look at. We as legislators need to responsibly implement Prop 2.”
Jane Perkins, lead counsel in the Kentucky and Arkansas cases, wrote in a legal analysis that Idaho’s proposal is also likely illegal and her group would “pursue all enforcement options in collaboration with state partners” were it to pass.
“Idaho has the opportunity to learn from the actions of other states,” she wrote. “Rather than implement a program that will soon be declared illegal in federal court, Idaho should save itself the exercise, along with hundreds of thousands in taxpayer dollars and, instead, implement a clean Medicaid expansion as passed by the voters.”
Meanwhile, Martin is proposing several changes to his bill. One, which was in an older version of Vander Woude’s bill, would give people making from 100 to 138 percent of the poverty level the option of staying on the exchange but wouldn’t require them to.
“I was trying to get closer to 277 without being 277,” Martin said.
Idaho Press Reporter Betsy Russell contributed.