Republicans take aim at Idaho Medicaid expansion. Democrats call bill a 'total disconnect'

Ian Max Stevenson, The Idaho Statesman on Jan 24, 2025

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Idaho Republicans have once again taken aim at health care costs that support low-income residents.

A House committee brought forward legislation Friday to repeal Medicaid expansion, the state program that uses mostly federal funds to provide health care coverage for about 90,000 Idahoans.

Passed by Idaho voters in a ballot measure in 2018, the proposal is expected to stir controversy at the Legislature as Republicans look to cut costs while offering tax cuts.

Forty states plus Washington, D.C., have adopted Medicaid expansion, which offers health care coverage to Idahoans who earn too much to be covered by standard Medicaid — slightly more than the federal poverty level — but not enough to qualify for private insurance subsidies on the state’s marketplace.

While former President Barack Obama’s Affordable Care Act required states to expand Medicaid coverage to continue receiving federal funding, the U.S. Supreme Court struck down that requirement in 2012, leaving it to individual states to decide whether to broaden the list of who qualifies.

Though the Idaho Legislature never did so, citizens brought a ballot measure in 2018 that earned support from more than 60% of the state’s residents.

As of December, 90,062 Idahoans had health coverage on the program, according to the Department of Health and Welfare.

But Republicans since then have complained about the costs of the program. Rep. John Vander Woude, R-Nampa, noted Friday that the expected implementation cost of the expansion in 2018 was $32 million, which has risen to $110 million in state money in the next fiscal year.

“We’re on a trajectory that I just don’t think we can afford to continue,” said Vander Woude, who introduced the bill.

While the federal government pays 90% of the program’s costs, Vander Woude said he worries the Trump administration might lower its payment threshold over its own spending concerns.

The two Democrats on the 15-member committee voted against introducing the bill. House Minority Leader Ilana Rubel, D-Boise, contended that it is “wildly inaccurate” to expect $110 million in cost savings to the state if the program is repealed, because of former state programs like the Catastrophic Care Fund that used to help hospitals pay for care of indigent residents.

Studies have also shown that expanded health care coverage decreases the number of emergency room visits for young adults and increases hospital financial performance.

Rubel said the expansion program has saved the state money overall, through savings at state prisons, in behavioral health and for county health care expenses. She also noted that the annual $1 billion in federal funds that enter the state’s economy through the program would disappear.

A 2023 report from Health and Welfare estimated the state would have to spend $78 million absent the expansion program to replace similar services.

“This (bill) I just feel would be so hurtful to so many people and is so at odds with the clearly expressed wishes of the people of Idaho that I can’t support even introducing it,” she said.

Rep. Megan Egbert, D-Boise, also voted against introduction.

In a statement, Rubel and Senate Minority Leader Melissa Wintrow, D-Boise, called the bill a “breathtaking example of the total disconnect between the GOP supermajority politicians’ agenda and the wishes and needs of Idahoans.”

The expansion has “saved countless lives” and “protected thousands of Idaho families from financial ruin and health disaster,” the statement said.

Rep. Lori McCann, R-Lewiston, said she was unsure she could support a full repeal of Medicaid expansion because she believed it would harm rural hospitals, but said she was interested in looking at other “sideboards” that could be placed on the program’s bottom line.

Vander Woude said he did not like the Catastrophic Care Fund, but acknowledged that if Medicaid expansion were to be repealed, the state may need to provide indigent care funds.

Sponsored by Rep. Josh Tanner, R-Eagle, the bill is expected to be scheduled for a public hearing. Last year, a complicated Medicaid expansion reform bill that would have likely led to the program’s repeal failed in the Legislature. Republicans have also previously failed to add work requirements to the program.

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