Idaho Supreme Court Rules Medicaid Expansion Is Constitutional

Feb 5, 2019

The Idaho Supreme Court has dismissed a lawsuit challenging the constitutionality of the state’s recent voter-approved Medicaid expansion.


In a 16-page opinion, Chief Justice Roger Burdick and Justices Richard Bevan and John Stegner rejected the arguments brought by the conservative Idaho Freedom Foundation affirm the law is constitutional.

Under the program, more low-income residents would be able to get health insurance coverage through Medicaid. The federal government will pay for 90 percent of new costs, while Idaho picks up the other 10 percent.

Represented by attorney Brent Regan, the foundation claimed that by writing into law that Idaho would adhere to federal Medicaid regulations, it tied the hands of legislators into the future who might want to alter the program or pull out entirely.

But the three justices say that’s not true.

Even if the feds changed the rules of the program, they say state lawmakers would still have a say.

“…because Medicaid is a cooperative federal-state program, if Idaho wanted to continue offering expanded Medicaid services, the Idaho legislature would have to decide to pass new legislation conforming with the amendment.”

They also argue that Idaho lawmakers approve the budget for Medicaid every year. “Thus, the Idaho legislature will control the ongoing nature of Medicaid through its annual appropriation of funds.”

The Idaho Freedom Foundation didn’t immediately respond to a request for comment.

Reclaim Idaho, the group that started the Medicaid expansion ballot initiative in 2017, applauded the decision.

"It is so good to know that not only is Medicaid expansion the law of the land, but now it’s been upheld by the highest court in the land," said Luke Mayville, a co-founder of Reclaim Idaho.

The opinion also notes the many instances throughout Idaho law that reference federal statutes.

“If we were to accept Regan’s argument that any reference to a federal statute delegates lawmaking authority to the federal government, then many of Idaho’s statutes would be unconstitutional, and in fact, the option of any cooperative federal-state program would be curtailed.”

Justices Robyn Brody and Gregory Moeller argue that Regan and the Idaho Freedom Foundation didn’t have standing to bring the case in the first place and didn’t want to make an exception, unlike their colleagues.

They say it should be dismissed out of hand and dissented with the other three justices who ruled on the merits of the case.

Brody and Moeller said that “judicial restraint” and the separation of powers should keep them from taking sides on an issue until there’s an urgent constitutional issue that comes up.

In a concurring opinion with the majority, Stegner rejects these arguments, saying the issue of “whether tens of thousands of Idahoans should have access to healthcare” qualifies as urgent.

“…rather than taking the quick off-ramp and letting this case languish through the trial court, only to work its way back to this Court, I opt to address the question head-on,” Stegner wrote.

“The constitutionality of [Idaho’s Medicaid expansion law] is not a difficult question. We deal with much more challenging and closer questions on a daily basis,” he wrote.

The court did not force the Idaho Freedom Foundation to pay the state’s legal costs.

The future of Medicaid expansion now lies in the hands of the state legislature. Some lawmakers are considering adding work requirements, co-pays and other restrictions that Reclaim Idaho and other advocates have rejected.

It’s unclear whether such proposals have enough support to pass.

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