BOISE — After hourslong debate, the Idaho Senate voted Friday to approve the much-amended Medicaid “sideboards” bill, adding work requirements for eligibility, as well as other limits.
The Senate voted 19-16 in favor of SB 1204aa, and it’ll now be sent Gov. Brad Little’s desk, where he will decide whether or not to sign the bill into law.
“This is a good bill, and it’s a good place to start,” said Sen. Mary Souza, R-Coeur d’Alene.
The bill, co-sponsored by Souza and Steven Thayn, R-Emmett, would add “sideboards” to the Medicaid expansion that Idaho voters approved in Proposition 2 in November. Among the many changes are allowing those between 100 and 138 percent of poverty to stay on the state insurance exchange, rather than automatically being moved to expanded Medicaid. The bill also requires that those receiving expanded Medicaid work at least 20 hours a week at minimum wage, and provide documentation of that. According to Souza, people earning a higher wage could work fewer hours. The bill says that a person could also instead prove that they were in work training at least 20 hours a week; or volunteering at least 20 hours a week; or enrolled half-time in educational programs, or any combination of those, to get on Medicaid expansion. 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.
“It does not lock them out for any length of time,” Souza said.
Other changes include:
— Requiring that patients get a referral from their primary care doctor to seek family planning services from any other provider.
— Ending expansion if the Affordable Care Act is declared unconstitutional.
— Calling on the Legislature to review expansion in January 2023 and discuss whether it should continue.
Several senators spoke against the bill as amended on Friday afternoon, pointing to an array of different concerns, including the fact that it’s not what the voters asked for, it comes with a hefty price tag and could be vulnerable to a court challenge.
The Medicaid initiative, which won support from 60.6 percent of Idaho voters in November, expands the state’s Medicaid program to low-income Idahoans who fall within the state’s health care coverage gap, meaning they make too much to qualify for traditional Medicaid but too little to qualify for subsidies to purchase insurance through Your Health Idaho, the state insurance exchange.
“This bill (1204aa) is not our best work,” said Sen. Janie Ward-Engelking, D-Boise. “There are too many unknowns not only in the implementation, but in the costs to the state. I don’t believe this bill represents what the people voted for.”
Ward-Engelking expressed concern with the impact the bill could have on CAT fund expenses if a person were kicked off of Medicaid and required emergency medical services — a concern also brought up during a Friday morning committee meeting on the amended bill.
Sen. Fred Martin, R-Boise, read from an attorney general’s opinion, sent out Friday, which says that the bill, as amended, “is likely to result in legal challenge.” He spoke against the bill, of which he was the original author, before repeated amendments.
“This has been a very emotional time for all of us,” Martin said. “I feel like we should have left weeks ago ... at least days ago.”
Sen. Grant Burgoyne, D-Boise, said the bill is “really an amendment to Proposition 2.”
“I think the bill and its amendments are unnecessary to implement the will of the people on this issue,” Burgoyne said. “There’s only one thing that was needed from us, and that was the appropriation.”
Majority Leader Chuck Winder, R-Boise, spoke in support, emphasizing the number of times the bill’s already been amended, adding that it eventually needed to make it to the governor.
“If you want to continue the fight, we can continue the fight. Or I think we should do what is best for a large group of people in our state,” Winder said. “ ... From my perspective, we’ve got 60,000 to 70,000 people we can help almost immediately get better health care in the state, or we can keep fussing around.”
Sen. Jim Rice, R-Caldwell, said he believes Idaho’s work requirements would be different from those overturned in Kentucky and Arkansas. Those who supported Medicaid expansion, he said, “Were told expressly, by the proponents of the bill, that it was for working Idahoans, not non-working Idahoans. ... It’s strange to me that we would then be told that Idahoans voted not to have any work requirement.”
He added that the “uniform response” he gets from “ordinary people in Caldwell” is they have no problem with the work requirement.
“They’re surprised there’s even any controversy about putting one on,” Rice said. “The path of prosperity for everyone that can is work.”
The bill, which originally began in the Senate, would have made some minor changes to Medicaid expansion, including a voluntary work training requirement. On Monday, the Senate added more restrictions, including mandatory work requirements, bringing it closer to an earlier House bill. After passionate debate on the House floor on Thursday, the House voted, 49-20, in favor of adding more restrictions, including removing health coverage from patients who don’t meet the mandatory work requirements. It was then sent to the Senate for agreement with the changes.
The Senate Health & Welfare Committee on Friday morning voted 5-4 against concurring with the House’s amendments, after several technical questions were raised about timing changes in the bill, amid other concerns.
Shortly after Friday’s vote, the Senate Democratic Caucus sent out a press release opposing the decision.
“We sent a bad bill to the House and we got back an even worse bill,” Jordan said in the press release. “Through compromise and hard work we came up with legislation that would have empowered Idahoans to get into good paying jobs while providing them with the healthcare they need and deserve. All of that was thrown down the drain for this new Frankenstein bill.”
Both Close the Gap Idaho and Reclaim Idaho are now calling on Little to veto the bill. Close the Gap stated in a press release that if it becomes law, it will “cost millions in administrative costs, while stripping coverage from eligible Idahoans.”
Post Register reporter Nathan Brown contributed to this report.