A bill to repeal a voter-passed Medicaid expansion program was submitted by Republican lawmakers in Idaho on Friday.
House Bill 58, which names Idaho House Assistant Majority Leader Josh Tanner, R-Eagle, as a sponsor, was introduced by Idaho House Health and Welfare Committee Chairman John Vander Woude, R-Nampa.
Vander Woude told the committee, “I just don’t think we can afford to continue on this trajectory.” And I absolutely believe that a closer examination is necessary.
The bill’s introduction sets the stage for a thorough committee hearing, which will include public testimony and a potential vote to move it to the Idaho House floor.
By a party-line voice vote on Friday, the Idaho House Health and Welfare Committee authorized the bill’s introduction. Only two Democrats on the 15-member committee, Rep. Megan Egbert of Boise and Idaho House Minority Leader Ilana Rubel, voted against initiating the bill.
Rubel stated that even though she plans to oppose certain measures but not all of them, she votes to introduce 99 percent of them.
“I just feel like this would be really hurtful to a lot of people and it’s so against the clearly stated wishes of the people of Idaho,” she added.
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What is Medicaid expansion?
Nearly 61% of Idaho voters passed a ballot measure to expand Medicaid in 2018, following years of delayed legislative efforts to close the Medicaid shortfall. In 2020, the law became operative. That law would be repealed by the new bill.
According to a 2023 survey conducted by the Boise-based public opinion research firm GS Strategy, support for expansion has increased after Idaho voters adopted the bill.
The Idaho Legislature’s 2025 Medicaid expansion plans: repeal or reform
However, a number of Republican lawmakers argue that Medicaid’s growing expenditure is mostly due to expansion, which they believe should be reined in.
A number of Idaho measures that would have revoked Medicaid expansion have failed in recent years.
According to some lawmakers, this year may open the door for bills that either repeal or reform Medicaid expansion. The Idaho Capital Sun previously reported that Republicans had secured control of the White House, both chambers of the U.S. Congress, and the Idaho Legislature, as well as a significant turnover in the Idaho House Health and Welfare Committee.
A closer examination of the state budget, according to some health policy supporters, reveals that Medicaid has actually experienced consistent budget growth. They also claim that Idaho’s Medicaid expansion has saved lives and reduced state spending in other areas.
According to the Idaho Press, approximately 90,000 people in Idaho were enrolled in Medicaid expansion in December.
According to the bill, Idaho would save $110 million if Medicaid expansion were repealed. There are politicians who are dubious.
According to the bill’s fiscal details, the state would save at least $110 million a year. However, other politicians expressed skepticism about the accuracy of that statistic.
Representative Lori McCann, a Republican from Lewiston, stated that she was unsure if she could back completely rescinding Medicaid expansion. She also questioned the accuracy of the bill’s estimated state savings.
In my district, there are numerous hospitals and counties with destitute money. I have a lot of rural areas, and this would be really harmful. I’m worried about this, and I’d like to see the full economic picture of what this would accomplish,” McCann stated.
However, she voted to propose the bill, stating that lawmakers ought to hold a full hearing to thoroughly review the bill and perhaps look into additional sideboards that could be useful.
Legislators have also proposed sideboards, which are essentially additional program restrictions like job requirements, to control Medicaid’s expenses.
According to a news release from the Idaho Joint Democratic Caucus, taxpayers would lose $1 billion in federal funding and reverse $80 million in savings for the whole Idaho government if Idaho Medicaid expansion were repealed.
Idaho’s Medicaid director informed lawmakers in 2023According to a recent Sun article, if Medicaid expansion were to be canceled, Idahoans would have to spend over $78 million more since they would no longer get federal assistance.
Hillarie Hagen, senior policy associate at Idaho Voices for Children, said in a statement that this is a dramatic attempt to reverse the will of the voters who chose to expand Medicaid and deny health care to 85,000 Idahoans in low-income families. Our uninsured rates would soar if we forced Idahoans back into the coverage gap, with rural areas of the state suffering the most.
Republican lawmakers were concerned that the federal government would cut additional compensation before voters in Idaho approved Medicaid expansion.
The federal government offered to cover Medicaid expansion programs at a greater federal matching rate of 90% as part of the Affordable Care Act of 2010, which encouraged states to extend Medicaid to a wider variety of low-income earners.
One of the few states that chose not to expand Medicaid was Idaho.
However, tens of thousands of Idahoans were left in a coverage gap for medical insurance assistance, known as the Medicaid gap, as a result of Medicaid’s refusal to expand. Individuals in the gap made too much money to be eligible for Medicaid, but not enough to be eligible for tax breaks on Your Health Idaho, Idaho’s health insurance marketplace.
Republican state legislators have long been concerned that if the federal government cut back on its additional funding, states would be left to foot the bill for expansion.
When considering the federal government’s deficit, Vander Woude stated that his greatest concern is that the government may decide to stop its higher match rate. According to him, the federal government might lower that to the usual match rate of roughly 70%, meaning Idaho would have to pay an additional $200 million.
The proposal to restore indigent health aid programs is not included in the bill.
The law does not require Idaho to reinstate state and local government indigent health care aid programs, as noted by House Democratic Leader Rubel.
Following the implementation of voter-approved Medicaid expansion, state lawmakers terminated the programs.
“Idaho spent a lot of money to make sure that hospitals didn’t bear all those costs through those programs that helped people who couldn’t afford high medical costs called the Catastrophic Health Care Fund, or CAT Fund, at the state level and the indigent health care fund in counties,” Rubel said.
Rubel stated, “I believe this fiscal note is completely incorrect.” Everything I’ve seen suggests that eliminating Medicaid expansion will actually cost the state more money than it would save. In terms of all the money we had to raise previously to make sure we wouldn’t lose all the rural hospitals, there have been significant reductions in mental health and corrections across the board.
If the bill passed, Vander Woude said, lawmakers might take a look at some of those choices. He did, however, admit that he wasn’t a huge fan of the CAT fund when it was available, and I still amn’t.
Vander Woude stated, “I think we might have to create some programs later that will encourage some costs if this goes forward.”
According to a revised committee schedule posted early Friday, the Joint Finance-Appropriations Committee, the budget-setting body of the Idaho Legislature, is set to determine the budget for the Division of Medicaid in the Idaho Department of Health and Welfare on February 26.
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