Susan Ripley

Susan Ripley

Idaho voters enacted Medicaid expansion in November 2018. More than 60 percent of the voters felt the ballot initiative was the right thing to do for an estimated 90,000 Idahoans who had no health care insurance.

The League of Women Voters of Idaho supported the effort to place Proposition 2 Medicaid expansion on the ballot through the signature gathering process and campaign once the measure qualified for the ballot.

However, that effort didn’t stop with the election once the measure landed in the state Legislature for funding. It is important to remember Medicaid expansion has been part of the health care discussion in Idaho since the federal Affordable Care Act became law in 2010. Various forms of expansion have been proposed by legislators but the efforts never got far — many never getting as much as a hearing.

Finally, it took the nearly herculean efforts of hundreds of volunteers seeking signatures on petitions throughout the state for expansion to be placed on the ballot. The measure extended Medicaid coverage to those earning up to 130 percent of the federal poverty level. Previously, those people were considered to be in the so-called insurance gap: making too much to qualify for Medicaid and not enough to afford insurance through the state’s insurance exchange.

Fiscal analysis and the experiences of other states showed expansion could result in savings or a break-even impact in as little as three years. This would be, in most part, facilitate by the federal government’s 90 percent share of the cost to fund the expansion and the decreasing need to use indigent and catastrophic funds supplied by the state and counties.

The greatest benefit would be for those who are eligible for expanded Medicaid coverage. They would receive health care services from a primary care physician instead of seeking help as a last resort from a hospital emergency room.

Unfortunately, the Legislature has diluted the original intent of Prop. 2. One sidebar to the proposition could exclude as many as 26,000 from coverage by requiring them to work in order to receive benefits also known as 1115 Work Requirements Waiver.

The proposed Idaho requirement would reject enrollees at the time of application if they aren’t already employed. Also, the monthly reporting requirements could result in thousands more being dropped from the rolls. That reporting includes filing for exemptions for those with disabilities or health conditions that are a barrier to work. That can exacerbate a difficult health condition.

Work requirements also mean the addition of costly bureaucracy to expansion expenses by creating a new level of administration to oversee and track thousands of enrollees. Cost estimates fall in the millions of dollars.

In order to place the work requirement on Prop. 2, Idaho needs a waiver from the federal government. The Idaho Department of Health and Welfare is preparing its application for the 1115 Work Requirement Waiver and is required to take public comment. The comment period closes Sept. 22. You can submit comments online through the Close the Gap website: or email to or send them to Attention: Cindy Brock, Medicaid Program Policy Analyst, Division of Medicaid, P.O. Box 83720, Boise, ID 83720-0009.

The League of Women Voters of Idaho supports Prop. 2 without the waivers. As written and enacted by the voters, Medicaid expansion is the best solution to a health care crisis that has plagued Idaho for years. Lack of proper health care keeps thousands of people from living successful and happy lives. The state needs educated and healthy residents to fill the needs of employers in the coming years.

Medicaid expansion is not a handout. It’s a way people, ill through no fault of their own, can begin their journey to good health. It is good public policy and fiscal common sense for the state to support a healthy population. Eliminating the work requirements would help that goal to become a reality.

Susan Ripley is the president of the League of Women Voters of Idaho.