Advocates urge lawmakers to protect Medicaid expansion

BOISE — Advocates for Medicaid expansion gathered at the Capitol on Tuesday to call on lawmakers to protect the program amid proposals to eliminate it.

The rally comes in the wake of continued efforts to repeal Medicaid expansion by Republican lawmakers — a service which about 90,000 Idahoans depend on for health coverage, the Idaho Press previously reported.

Dr. Darin Lee, an emergency physician and the vice president of medical affairs at Saint Alphonsus Regional Medical Center, spoke to the fears his patients have faced due to skyrocketing medical costs.

“I cannot tell you how many times I’ve cared for uninsured patients who delayed seeking care because they feared the financial burden of medical bills,” Lee said.

He gave examples of patients, such as one with a persistent cough who waited more than a year before seeking care and was then diagnosed with lung cancer, or another who had a treatable wound but waited so long they lost a limb because of a severe infection. He also spoke of a man who had chest pain but did not seek treatment until he went into cardiac arrest.

“As I spoke to his wife about our unsuccessful attempt to revive him,” Lee said, “she broke down in tears and explained to me that he would not come in sooner because he was afraid of the costs.”

Disparities in health care access and quality remain a challenge for areas without an urban advantage. Idaho is one of the most rural states in the Union, with the Idaho Division of Public Health classifying 35 of Idaho’s 44 counties as rural in 2022, and 16 of these being remote, or counties with less than six people per square mile. A 2023 Georgetown University study found that rural populations bear the brunt of Medicaid reductions, with health care providers in these areas disproportionately relying on Medicaid for patient coverage.

Hillarie Hagen, senior policy associate for Idaho Voices for Children, said she was concerned about Idaho’s rural population dependent on Medicaid.

“Among adults younger than 65 in Idaho’s small towns and rural areas, about 17% are covered through Medicaid, compared to about 15.7% in metro areas,” Hagen said. “It’s alarming to see proposals that would end Medicaid expansion. Pushing Idahoans back into the coverage gap would cause our uninsured rates to skyrocket, with rural Idaho facing the greatest harm.”

In 2018, nearly 60% of Idaho voters cast ballots in favor of Medicaid expansion. Prop 2 expanded coverage to working persons younger than 65 whose income was above the federal poverty level, but not enough to cover private insurance.

Medicaid expansion has since seen several repeal efforts. In 2024, Rep. Jordan Redman, R-Coeur d’Alene, proposed a bill that would repeal expansion if certain conditions were not met. Redman’s bill died in committee after being met with a largely negative response.

Randy Johnson, American Cancer Society Cancer Action Network government relations director for Idaho and Nevada, argued that these “compromise” actions are no better than a repeal — still cutting programs by creating impossible conditions to meet.

“The next bills that we’re going to see come forward are your compromise bills,” Johnson said. “We’re going to see them bring that back as a compromise. For us, that’s unacceptable.”

Critics of Medicaid expansion — including Rep. John Vander Woude, R-Nampa, who this year has proposed its repeal — argue that costs to maintain the program have exceeded initial estimates. In spite of this, advocates argue that Medicaid expansion has given the state more than it has taken — both fiscally and by saving lives.

A federal match rate means Idaho taxes cover 10% of the cost of Medicaid expansion, with the federal government covering the other 90%. A 2023 report from the Department of Health and Welfare estimated the state would have paid $77 million in other costs without the program in place.

A November 2024 documentary created by the American Cancer Society Cancer Action Network and Voices for Children showcased the lives of several Idaho residents, many of whom said their lives would have been jeopardized without Medicaid expansion, the Idaho Press previously reported.

Johnson cited recent tax cut proposals as proof the state is not imposed to lend a helping hand to its constituents.

“This isn’t breaking the bank,” Johnson said. “There’s money in here to take care of Idahoans.”

To date, Idaho is one of 41 states (including Washington, D.C.) that have expanded Medicaid coverage since the 2012 Affordable Care Act.

“This is why we’re here today, to protect Medicaid expansion, to honor the will of the people, and to ensure that Idaho remains a place where we take care of one another,” Johnson said Tuesday. “Because at the end of the day, this isn’t just about health care, it’s about who we are as a state and as a community.”

Schwicht may be contacted at newsroom@idahopress.com.