After hours of debate, the House has voted 45-25 in favor of HB 277, Rep. John Vander Woude's controversial Medicaid "sideboards" bill, which includes mandatory work requirements and more. There was bipartisan opposition, with 11 Republicans joining all 14 Democrats in opposing the bill. Here's a full report from Post Register reporter Nathan Brown:
BOISE — A bill to add work requirements and other restrictions to the Medicaid expansion voters approved in November passed the Idaho House 45-25 Thursday.
It remains to be seen whether this attempt by House Republicans to restrict expansion will become law. A little before the House voted, a Senate committee voted to advance a competing Senate bill, sponsored by Senate Health and Welfare Chairman Sen. Fred Martin, R-Boise, that would make fewer changes to Medicaid expansion and would add a voluntary job training program instead of mandatory work requirements.
Senate President Pro Tempore Brent Hill, R-Rexburg, said Thursday he intends to give a Senate committee hearing to the House bill, also raising the possibility the hearing might not be in Martin’s committee. Hill said he hopes the whole Senate can vote on it, and noted it had been scaled back from what some House Republicans wanted earlier in the session.
“I think some of what people are calling sideboards are really enhancements,” Hill said.
Hill noted the work requirement has been reduced from 30 hours a week in an older version to 20 hours now, and it contains numerous exemptions, such as for students, people who are unable to work and people with children under 18 at home.
“It’s more than just deciding which of the two you like the best,” he said. “It’s recognizing we’re a bicameral system” and need to find something that can get a majority in both houses and that Gov. Brad Little will sign.
Martin’s bill would come to a vote in the full Senate early next week, unless the Senate suspends its regular rules to vote earlier.
All 14 House Democrats voted against the bill, as did 11 Republicans. Five of them were members of the House Health and Welfare Committee. That committee voted Wednesday to send the bill to the House floor with no recommendation; if the five had joined the Democrats on the committee, the bill wouldn’t have advanced. Committee Chairman Rep. Fred Wood, R-Burley, who spoke at length and in detail against the bill on the House floor, said he voted to advance the bill because he thought the entire House should discuss it.
The House’s bill would ask for several federal waivers. As well as the work requirements waiver, another would ask to cover people making from 100 to 138 percent of the poverty level on the Your Health Idaho state exchange rather than Medicaid. Another waiver would say enrollees could not receive family planning services from anyone except their primary care doctor without a referral from that doctor. The bill would also end Medicaid expansion, unless the Legislature acts to extend it, if the share of the cost covered by the federal government drops below 90 percent. Rep. John Vander Woude, R-Nampa, who is sponsoring the bill, said about 11,000 Medicaid expansion beneficiaries are either not working at least 20 hours a week or not exempt and thus would fall under the work requirements.
Rep. Bryan Zollinger, R-Idaho Falls, who opposed Medicaid expansion and supports work requirements, said everyone wants everyone to have health care, but rising costs are the real problem and the Affordable Care Act has made that worse.
“This is a continuation and expansion of a socialist program,” he said.
Zollinger said he has talked to people who voted for Proposition 2 but also support work requirements.
“I think it’s a false premise to believe that everyone who voted for Proposition 2 is against the work requirements,” he said.
House Assistant Minority Leader Rep. Ilana Rubel, D-Boise, estimated the bill would lead to a second “Medicaid gap” of about 22,000 people, adding the number of people between 100 and 138 percent of the poverty line who are uninsured now to the number of people who, based on Arkansas’ experience with work requirements, might get kicked off of Medicaid. Medicaid expansion, she said, had been debated and researched for years before voters approved it.
“It’s disturbing to me we’re going to upend one of the most thoroughly vetted pieces of policy that I’ve seen in seven years and replace it with this half-baked scheme, if you will,” Rubel said.
Rubel talked about her childhood growing up in a public housing project and said making life harder for the poor does not help them improve.
“Every single day came with a dozen new difficulties and humiliations,” she said. “I believe poverty carries powerful disincentives on its own.”
Rep. John Green, R-Post Falls, who sponsored an unsuccessful bill to repeal Medicaid expansion earlier this year, said the bill would “temper the stain of democracy that threatens our republic.”
“When the majority of people say the state can use the force of law to take money from our neighbors and give it to someone they think who needs it, that’s socialism,” Green said. “And socialism and democracy and antithetical to our republic.”
The Department of Health and Welfare estimates it would have to hire 19 new employees if the bill becomes law, 18 of whom would administer the work requirements. Opponents of the bill pointed repeatedly to these increased costs and questions about the bill’s estimated fiscal impact, and also worried it would lead to increased costs in other areas of the budget that could be avoided with full expansion. Rep. Sally Toone, D-Gooding, worried how county indigent fund spending and rural hospitals would be impacted by a higher number of uninsured people.
“Hospitals are usually our second-highest employer in our rural communities behind our schools,” Toone said. “When they close because their margin of operation is so low, that’s devastating to our rural communities.”
Wood said he plans to introduce a bill Friday morning to shift some county indigent spending into Medicaid expansion to pay for part of the costs.
“If we have people in the gap population at all, we’re not going to be able to end either one of those programs,” he said.
Wood criticized the bill piece by piece, from the work requirements to the partial expansion to 100 percent of poverty to the family planning waiver.
“This idea that (if) you have to have family planning services, that you have to have a referral to go to your OB-GYN physician if you’re female — I can’t imagine a single female in this body who would tolerate that,” he said.
Wood said this would lead to more unplanned pregnancies, since Medicaid recipients would need a referral to get contraceptives at a public health clinic.
“The quickest way to make abortion go away is to make unintended pregnancies go away,” he said.
Rep. Wendy Horman, R-Idaho Falls, who is a vice chairwoman of the Legislature’s budget-setting committee, said the bill would help control the growth of the Medicaid program, which is expected to be set at $2.8 billion for next year. The state-funded portion is expected to increase by $99 million, to $684.4 million. Horman said Medicaid expansion has cost much more than projected in some other states, and it could threaten funding for other programs if it continues to grow or if the federal government cuts its share of the funding.
“It has important fiscal sideboards on it that will help us manage this expansion in a way that’s fiscally responsible for those of us who are being served as well as Idaho taxpayers,” Horman said.