Idaho House Republicans pushed through a bill Thursday that would tack on work requirements, among several other restrictions for those enrolling under the state’s voter-approved Medicaid expansion program.
The move came after GOP lawmakers suspended rules to debate the bill from Rep. John Vander Woude (R-Nampa) less than a day after it was released from committee without a recommendation.
It passed 45-25, with 11 Republicans joining all 14 Democrats in opposing the measure.
The bill would also request permission from the federal government to require those earning 100-138 percent of the federal poverty level to buy their insurance on Idaho’s health insurance exchange.
Rep. Gayann DeMordaunt (R-Eagle) says that should give patients choices.
"There is dignity in walking into a medical office with a card that does not say Medicaid, that has choice associated with it," DeMordaunt says.
The Centers for Medicare and Medicaid Services has never approved such a waiver.
Rep. Ilana Rubel (D-Boise) was among those giving impassioned speeches against the bill.
Growing up, Rubel says, she and her mother were both enrolled in government-sponsored health insurance, living in a public housing complex “where there were roaches out in the hall.”
She says forcing people to work when they may not be able to and report their hours to the state isn’t going to help anybody.
“Every single day came with a dozen new difficulties and humiliations and I believe poverty carries powerful disincentives on its own and I don’t believe that we need to layer on to that, ‘Plus, you can die of an avoidable illness,’” Rubel said.
18 new state employees would need to be hired to ensure those enrolled in Medicaid are working, going to school or volunteering at least 20 hours each week.
Several people would be exempted, including parents and caretakers of children or those who are disabled, those enrolled in a substance abuse program or someone applying for or receiving unemployment insurance.
Several Republicans referred to the measure as a compromise that will help rein in costs they fear will only rise when the Idaho economy cools off from a several-year high.
“[This bill] will help us manage this expansion in a way that’s fiscally responsible for those who are being served, as well as Idaho taxpayers,” says Rep. Wendy Horman (R-Idaho Falls), a co-chair of the budget-writing Joint Finance-Appropriations Committee.
According to a disputed fiscal analysis, the bill saves $25.6 million each year, but opponents say that money could be easily drained by those who don’t want to sign up for insurance through the exchange. Their hospital bills could still fall on individual counties and the state.
Rep. Fred Wood (R-Burley), a retired physician, originally voted to move the bill to the House floor from the committee he chairs without a recommendation.
But Wood picked at nearly every facet of the bill, including mandatory work requirements.
State legislators, he says, are technically part time employees, yet they receive health insurance coverage.
“I signed up here 13 years ago for this insurance. Nobody yet has ever come around and asked me in July how many hours I worked,” he says.
Wood says maybe the legislature should audit itself, referring to monitors as “parole officers.”
Another part of the bill would force anyone seeing a doctor for family planning care or supplies be first referred by their primary healthcare provider.
“I can’t imagine that a single female in this body would tolerate that,” in order to see an OB-GYN, Wood said.
The bill now heads to the Idaho Senate, which is considering a much different Medicaid expansion bill.
Sen. Fred Martin’s (R-Boise) proposal would set up a voluntary work training program, among a handful of other provisions shared between both bills.
House lawmakers have also not yet approved the fiscal year 2020 budget for Medicaid, setting up a potential showdown that House Speaker Scott Bedke (R-Oakley) said last week may keep lawmakers in Boise until April.
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