Idaho health committee chair says Medicaid expansion repeal bill is just to open ‘discussion’

One of Idaho’s health-policy lawmakers on Friday proposed repealing the state’s Medicaid expansion law — going against his own recommendation to the Idaho Legislature, to keep the program mostly untouched for now.

Rep. John Vander Woude, R-Nampa, who chairs the House Health and Welfare Committee, said his intent is to open a discussion about Medicaid’s costs to the state.

“In conversations that I’ve had, I think we need to take a real good look at what this program is costing us and what benefits we’re getting out of it,” he said. “So I would like to have the committee introduce this (legislation) so that we can have that discussion.”

The bill would repeal Medicaid coverage for Idaho’s low-income adults.

While Vander Woude pitched the bill as an opening for dialogue, its language is not focused on requiring the Idaho Legislature to discuss Medicaid’s costs and benefits. That conversation is already happening in the Legislature on several fronts:

• as lawmakers consider the Department of Health and Welfare pending budget request;
• in a cost-containment study whose preliminary results were presented to the Legislature this week;
• and as state officials went before the House and Senate health and welfare committees, to update them on Medicaid expansion so the committees could make a formal recommendation on the future of Medicaid expansion.

Idahoans voted by 61% in the 2018 election to expand Medicaid so that it would cover adults whose income is too low for private health insurance.

After that ballot initiative passed, the Legislature decided to require the House and Senate health and welfare committees to consider the cost and outcomes in the first few years of expansion; and then recommend what the Idaho Legislature should do with the program.

Vander Woude sent his committee’s recommendation to Idaho House Speaker Mike Moyle, R-Star, on Jan. 31.

“Although the committee has serious concerns regarding the unsustainability of the current increased budget request, we concluded Medicaid expansion should remain in effect,” the letter said. It made several recommendations, though, including:

• to pursue federal approval for some Idahoans — those with income at or slightly above the federal poverty line — to have the option of getting private insurance on Idaho’s health insurance exchange;
• to take steps to move those with expanded Medicaid into a “managed care” plan, to more closely manage Medicaid claims;
• and for the committee to re-evaluate Medicaid expansion again in 2025.

The House Health and Welfare Committee approved Vander Woude’s request to introduce the bill, which sets it up for a public hearing and a committee vote.

“For me, this is getting the discussion to where, maybe, the public can really get a full understanding of how expensive this is going to be down (in) the future and what it currently costs,” said Rep. Mike Kingsley, R-Lewiston.

The committee’s three Democratic members voted against introducing the bill.

“I will normally vote to print almost any and every piece of legislation to open the discussion. But this one I cannot,” said Rep. Ilana Rubel, D-Boise. “I just think (of) the damage done and the anxiety caused to hundreds of thousands of Idahoans who rely on this coverage, and the undercutting of what I thought was the fairly clearly expressed will of this committee was that we not do this this year.”

In response to the legislation Friday, one of the leaders of the push for a Medicaid expansion ballot initiative said it was “shocking.”

Vander Woude “claims he’s just starting a discussion,” Reclaim Idaho co-founder Luke Mayville told the Idaho Capital Sun. “But he’s clearly opened the door to a repeal of the program. It is reckless and irresponsible for the committee to introduce this bill.”

Repealing the law would “strip health care coverage from over 100,000 Idahoans and it would betray the will of Idaho voters …” he said.