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Lawmakers unsure about tackling Medicaid in 2013

Expanding Medicaid to cover more low-income Idaho residents could save state and local taxpayers tens of millions, according to a state-financed report released the week of March 18. But lawmakers aren’t sure if there’s time or political will to tackle the issue during the 2013 session.

House Health and Welfare Committee Chairman Fred Wood, R-Burley, said March 22 during a meeting in the Capitol that he agrees Medicaid should be expanded, as foreseen under President Barack Obama’s health care overhaul.

“My heart is with you,” said Wood, a medical doctor, when pressed by lawmakers including Sen. Dan Schmidt, D-Moscow, to take up the matter this year.

However, “at this point in time, a decision has not been made … with respect to that,” Wood said.

Idaho state and county tax savings combined through 2024 could total $85 million, if the low-income health insurance program is extended to cover 150,000 more people who currently aren’t in the program and Idaho simultaneously repeals its existing system for paying the medical bills of people without any form of insurance, according to the new report, released by the Idaho Department of Health and Welfare.

Despite these numbers, however, Republicans have exhausted considerable political capital on another key provision of President Obama’s 2010 overhaul by passing a state-based health insurance exchange this session, which is due to end by next Friday.

With time so short, GOP appetite to tackle Medicaid — and another bruising round of debate — is limited.

Additionally, Gov. C.L. “Butch” Otter continues to oppose expanding Medicaid, at least until he wins reforms to boost patient responsibility.

Last year, Otter commissioned a 15-member committee to scrutinize how expanding Medicaid to more people, a provision of the 2010 Patient Protection and Affordable Care Act that the U.S. Supreme Court last June ruled was optional, would affect Idaho.

The 15-member panel reviewed the updated savings projections this week, and was in the process Friday of sending Otter a letter urging him to back Medicaid expansion.

Idaho Hospital Association president Steve Millard, a member of Otter’s panel, said after the meeting March 22 that it would require the full force of the Republican governor’s leadership, if something is to happen this session.

“I don’t know if he appreciates the urgency,” Millard said. “Our letter shows that in spades, the urgency.”

Jon Hanian, Otter’s spokesman, said the governor hasn’t yet received the panel’s letter, but is keeping track of developments — including the push by the Idaho Department of Health and Welfare to secure an agreement from the federal government to allow the state to modify its Medicaid program for any newly eligible people.

Health and Welfare Director Dick Armstrong is seeking changes that promote patient responsibility and encourages providers to focus on outcomes, rather than simply providing services for which they can bill the government. He’s optimistic to win an agreement from the U.S. Department of Health and Human Services and could likely have a new program in place during 2014, Armstrong said Friday.

So far, however, Hanian says nothing has occurred to move Otter from the position he took in January: Idaho should hold off on expanding Medicaid until a broken system has been fixed.

House Minority Leader John Rusche contends Medicaid expansion may be more important for Idaho than was creating a state-based insurance exchange, approved on Thursday afternoon after a combined 16 hours of debate over three days on the floors of both the Senate and House. Among other things, it would move tens of thousands of Idaho residents into a system of medical care that includes mental health services, he said, a departure from the existing program that pays the medical bills of poor patients only after treatment.

Even so, Rusche concedes opposition to Medicaid expansion will be fierce, with so many Republicans ideologically opposed to what they dub “Obamacare.”

“Politics are what’s going to block it,” said Rusche, D-Lewiston and former insurance executive.

 

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