Lawmakers again seek to repeal Medicaid expansion

BOISE — Idaho lawmakers are trying again to repeal Medicaid expansion, which would revoke health coverage for around 90,000 Idahoans.

Voters in 2018 approved the expansion of Medicaid coverage to adults who fell in the gap between qualifying for traditional Medicaid and being able to afford the state health care exchange.

“We’re on a trajectory that I just don’t think we can afford to continue,” Rep. John Vander Woude, R-Nampa, told the House Health and Welfare Committee on Friday.

The bill is also sponsored by Rep. Josh Tanner, R-Eagle.

The committee voted on party lines to introduce the bill, known as voting “to print,” with the two Democrats voting against it.

“Everything that I’ve seen indicates that it would actually cost the state more to get rid of Medicaid expansion than it would save … I will vote to print 99% of bills, even if I intend to oppose them on the substance, but I don’t vote to print 100% of them,” Minority Leader Rep. Ilana Rubel, D-Boise, said. “This one I just feel would be so hurtful to so many people, and it’s so at odds with the clearly expressed wishes of the people of Idaho that I can’t even support introducing it.”

Rubel noted that before Medicaid expansion, the state and local governments had costs through the previous catastrophic health care program, known as CAT, and local medical indigent costs that helped pay for uninsured people who could not afford their care.

The state in 2021 dialed back indigent care and the catastrophic health care program, requiring that anyone eligible for any form of Medicaid or to purchase private health insurance who isn’t covered to be ineligible for assistance, the Idaho Press reported. It also eliminated state funding for public health districts.

In 2023, the Department of Health and Welfare gave a required report on Medicaid expansion and estimated that the state would have spent more than $77 million in other costs without the program in place, while that year expansion population costs totaled around $68 million in state funds.

At the time, Juliet Charron, who was the administrator of the Medicaid program and is now the deputy director of Medicaid, said the state would need to boost spending for crisis centers, local indigent costs, hospitalizations and substance use disorder services within the Department of Correction without Medicaid expansion.

Vander Woude said Friday the bill would not restore the CAT fund or other programs that would cover indigent costs.

Rep. Lori McCann, R-Lewiston, said she would support introducing the bill so it could get a full hearing, but she’s “not sure” she would support a full repeal.

“The counties and hospitals in my district, this would be very damaging, and I have a lot of rural areas, so I have a concern,” McCann said. “I’d like to see an entire economic outlook of what this would do exactly.”

As of December, there were 90,062 enrolled in the expansion program, according to the health department. The costs in the programs make up around 24% of total Medicaid expenditures. In all, the program cost around $1.1 billion of mostly federal money, with state general funds costs coming to about $82.2 million.

Vander Woude has proposed repealing the program before, including in 2023 shortly after the committee he chairs recommended that it stay in place.

In 2024, Rep. Jordan Redman, who also sits on the Health and Welfare Committee, proposed a bill that would threaten to repeal expansion if a series of conditions weren’t met. Opponents of the bill said the changes required were unrealistic and all but guaranteed a repeal of the program.

Redman’s bill died in committee after two hours of overwhelmingly negative testimony.

The American Cancer Society’s advocacy arm, the Cancer Action Network, or ACA CAN, in Idaho has been a vocal opponent of all efforts to diminish or eliminate the program.

“We’ve been anticipating the threat to Medicaid expansion for a while now,” said state government relations for the action network Randy Johnson.

Johnson said the group has been meeting with lawmakers ahead of the session and trying to show them the value of the program. He highlighted that the expansion voter initiative passed with 60% of the vote.

He said the group additionally had concerns on the fact that there’s no replacement in the bill for those services or costs incurred by people who would become uninsured. He said the program as it stands “is working.”

“There’s no backup plan,” Johnson said. “They’re just looking to kick folks off their health care coverage and really tell everyone else, ‘good luck,’ “

Vander Woude’s most recent bill will come back for a full public hearing.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.