John Vander Woude House sideboards

Rep. John Vander Woude, R-Nampa, opens debate in the House on SB 1204a, the Medicaid sideboards bill, on Thursday, April 4, 2019.

Opening debate on SB 1204 as amended and amended again, Rep. John Vander Woude, R-Nampa, told the House, “I jumped on this bus and I’ve been trying to jump off of it, but I haven’t found a new driver.” He said, “I figure if you don’t know what’s in the bill, then you probably haven’t been paying any attention for the last three weeks.”

Temporary Rep. Molly Page, who is filling in for Rep. Muffy Davis, D-Ketchum, was the first to debate. “I’m just an everyday citizen,” she told the House. “I came here with the perception that thorough analysis is done before a bill is passed. As this week has progressed, I’m not feeling as confident.”

At the committee hearing on SB 1204a yesterday, she noted, no one in the room could answer questions about where numbers in the bill’s fiscal note came from, including the deputy director of the state Department of Health & Welfare. “Every person in the room spoke in opposition to the bill, yet none of them mattered and the bill advanced,” Page said. “I realize that making the sausage is complicated and messy, but in having witnessed such a rushed and pre-baked process, I am disappointed in how our government works.”

Rep. Brooke Green, D-Boise, said, "Quite frankly in three hours, we’ve created a new bill. ... Can we quite honestly state that this bill was put together in good faith in front of the public?" At that point, Rep. Megan Blanksma, R-Hammett, loudly shouted, "Objection!"

She objected that Green was questioning the motives of other lawmakers. House Speaker Scott Bedke cautioned Green not to do that. She concluded, "We have taken the public out of the policy making process."

Acting Rep. Sara Toevs, who is filling in for Rep. Sue Chew, D-Boise, said, "These barriers have not proven to be cost-effective in other states. These barriers limit access to preventive care. ... As a taxpayer, it is costly to me -- we pick up the bill for this uninsured care, and it is costly to the workers. ... This bill does not address the needs of the working poor or reflect the will of the voters of Idaho."

Rep. Ilana Rubel, D-Boise, said the House has "landed on the worst possible solution" after a full session of debating Medicaid expansion. "We've pulled out the only part that would help them comply with the work requirement," the work skills training program; she noted that in committee, that was given as the reason the bill needed to be amended, that the training program had been inadvertently deleted by Senate amendments.

"It's if possible worse than it was before," Rubel said. She said what the bill does now is spend $2.8 million to "hire 13 people to go chase around poor people and kick them off Medicaid expansion."

"It's totally inappropriate, it's expensive," Rubel said. "It does not achieve the objectives of SB 1204, it does not achieve the objectives of Proposition 2."

Rep. Julianne Young, R-Blackfoot, said, "I think we have to question seriously whether the voters would have passed it if we said this is going to help the people to refuse to work. ... We are giving them an opportunity to choose, and that's what freedom is all about. ... Freedom from responsibility is dependency, and those who are dependent cannot be free."

Rep. Barbara Ehardt, R-Idaho Falls, lauded Young's comments, and said she herself has in the past worked four jobs. She said people shouldn't be asked to help anyone who won't work.

Rep. Wendy Horman, R-Idaho Falls, spoke in favor of the amended bill. She said she believes the costs will be less than Rubel anticipated, as the Department of Health & Welfare could use existing employees for some of the work. "They run about an 8 percent vacancy rate," she said. So, she said, "We can provide personnel costs, but they do not need the FTP's, in my opinion."

Rep. Megan Blanksma, R-Hammett, said the work training program would have added "additional bureaucracy," and removing it "would create savings." There are existing work training programs through the private sector, she said, and through the Department of Labor. Blanksma also said the family-planning clause is "completely gender neutral" and doesn't only apply to women. "The intention of the referral process is to show cost savings," she said.

She said 20,000 people who now are on the insurance exchange "can keep their insurance" under the bill, rather than shift to the newly expanded Medicaid program, unless they choose to. She said she has friends who are embarrassed that their kids are on Medicaid, and being on the exchange instead is a "point of pride."

Rep. John Gannon, D-Boise, said, "Probably my principal concern with the bill is this referral idea. I think people are capable of choosing their own physicians and their own doctors. I'm concerned when any kind of mandate is made that you must see a particular physician or go through any kind of a delaying process. ... I think people still in this country deserve a choice of providers and I think it should be their choice."

Gayann DeMordaunt House debate

Rep. Gayann DeMordaunt, R-Eagle, debates in favor of SB 1204aa, the much-amended Medicaid expansion sideboards bill, in the Idaho House on Thursday, April 4, 2019 at the Idaho state Capitol.

Rep. Gayann DeMordaunt, R-Eagle, said, "There is not a single individual on this floor that has not spent time considering ... Medicaid expansion. ... We have considered it for over a year. ... Including those amendments that were most recently passed. We have vetted those previously. ... We have had those that have filled our committee rooms. We have had those that filled our Capitol halls. There are those of our constituents that have not been here. ... Many of those have not been here because they are at work. It seems reasonable for us to be representing those voices while they have not been in the hallways or the hearing rooms. It seems reasonable that we should be considering a requirement for those who are able-bodied to be at work." She said lawmakers have considered the amendments "carefully, and with an eye to serving all of our constituents."

Rep. John McCrostie, D-Boise, said, "I politely disagree with the good lady from 14. ... We have been talking about this for five years, and we have done nothing about it. ... We don't take any action. What is talk without taking action? And so the people of Idaho took this into their own hands." He said, "They came to a conclusion, and the conclusion they came to was Prop 2, so I support the original Prop 2." He said he's heard from numerous constituents about the issue, not just in the Capitol, but through calls, emails and more. "They have spoken to us, and they spoke to us at the polls -- 61 percent of them said that they want Prop 2 as passed," McCrostie said. "And I stand against this."

Rep. Bryan Zollinger, R-Idaho Falls, said, "Just assume that there are 5,000 people because of this work requirement ... (who) decide not to sign up under this. That savings would be $44.5 million, if only 5,000 people decided not to comply with the work requirements for whatever reason. That's a $5 million savings to the state. ... We're tasked with a very difficult job here," in terms of finding ways to fund services, he said. "This plan is a great plan. ... The intention of our bill is to provide coverage. ... Every single person that wants to be covered can be covered." He said the removal of the work-training program that was in the earlier version of the bill would save $1.3 million a year. "There are plenty of volunteer programs out there to get training, other things that they can do," Zollinger said. "I think we all believe that if you can work, you should bear your share of the burden. ... Work is a sacred principle." He called SB 1204aa "a wonderful bill."

Rep. Doug Ricks, R-Rexburg, said, "People in my district voted overwhelmingly against on Prop 2." He said his constituents support work requirements. "Most Idahoans are hard-working, they want to work. There are a lot of people that are working, sometimes two jobs, that have a difficult time trying to pay for medical premium or medical care. ... They're the people that need this help and they're the people that are going to get it. He said "there's a lot of church groups and others" that provide assistance with job skills training.

Rep. Scott Syme, R-Caldwell, spoke about "the referral process that's in this." He talked about a program in which a family doctor served as a "quarterback," and, "He always managed what their care was. ... It worked really well. People got their whole health looked at, and not only that, it saved money, because people didn't go to a specialist you didn't need to go to."

Rubel, debating for the second time, said the family planning referral requirement was fully explored, and "there are absolutely no savings here." That's because specific services are reimbursed at set fees, she said, regardless of from which provider they're obtained. "There's no cost savings here. All it is is just a barrier to people of both genders, I guess, but it will primarily affect women," she said.

Rubel said, "There's a very big difference between working, and being able to produce rock-solid documentation that you are working. ... That's where people get tripped up is through that paperwork piece."

Blanksma, also debating for the second time, said, "The waiver is actually a test program, that's what an 1115 waiver is, and we're supposed to show cost savings. ... I think it's important to really understand the purpose of that. I think there have been intentions implied in that that are completely inaccurate."

Erpelding asked Blanksma, "In the referral program, are there currently people who would provide planning services who would be denied by Health & Welfare and not be eligible to participate in a referral program?" Blanksma said, "I don't believe so. ... Most of the time for most services, they are all provided within that patient-centered medical home ... or at the request of the patient, if their primary-care physician was so willing." She said, "The whole point of the component is that patient-centered medical homes show cost savings. It's a given."

Wintrow then asked Blanksma, "Honestly, why then single out this particular medical process to do the referral, rather than many other medical processes we could go through?" Blanksma said, "This is a particular area of care where most of the services can be provided within the patient-centered medical home."

"I would respectfully disagree with the good lady," Wintrow said. "I have a family doctor ad I have a gynecologist and I go to separate places for those services, and I choose to do that for a reason. ... Respectfully, I would disagree."

In his closing debate, Vander Woude thanked everyone for the time they've devoted to the issue. He said as far as the fiscal note, "I have an updated one that's considerably different." He said that illustrates how difficult it is to estimate costs on this issue.

Betsy Z. Russell is the Boise bureau chief and state capitol reporter for the Idaho Press and Adams Publishing Group. Follow her on Twitter at @BetsyZRussell.

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