BOISE — After another day and another hearing, the fate of Medicaid expansion in Idaho is still in limbo.
The Senate Health & 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.
Brian Whitlock, president of the Idaho Hospital Association, who was next up to speak after the news broke, set aside his prepared statement, and said to laughter, "I think HB 277 is in need of major surgery."
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 have wanted to see 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 HB 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 SB 1204 heads to the House, the House would have the opportunity to amend it. However, if the Senate amends HB 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 like 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 lobbyist and Vice President Fred Birnbaum testified in favor of the bill, and everyone else was against it, with more than 50 people signed up to oppose the bill. Its costs loomed as a major concern.
“This particular bill creates unreimbursed care, pure and simple,” said Idaho Association of Commerce & Industry President Alex LeBeau, who urged lawmakers to support a voluntary work training program instead.
Christa Rowland, director of community impact for United Way of the Treasure Valley, told the senators, “Let’s not spend tens of millions to create barriers and end up with Idahoans worse off. You got it right with the Senate bill. Let’s grow pathways, not barriers.”
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 ripple of surprise in the room as people looked at their phones to find out what had happened.
But Martin said afterward, "I'm not sure if that changed the vote. I think it solidified the vote."
“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 maybe ... 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 Boise Bureau Chief Betsy Z. Russell contributed to this report.