- Associated Press - Wednesday, June 18, 2014

BOISE, Idaho (AP) - Even if an Idaho work group agrees on how to redesign the state’s Medicaid program, members concluded Wednesday that lawmakers are not likely to consider the option because “Medicaid expansion” has become a toxic term in the Legislature.

Gov. C.L. “Butch” Otter has repeatedly said he does not want to expand the state’s current Medicaid program but has appointed a 15-member group to consider other possibilities.

The panel first met in 2012 and recommended expanding Idaho’s Medicaid eligibility requirements, but that has been ignored for two years.

“The issue has not been addressed by the last two legislative sessions, even though there is a growing consensus that redesigning Medicaid is essential to the health of Idaho,” said Dick Armstrong, director of the Idaho Department of Health and Welfare.


Currently, more than 70,000 Idahoans fall into a gap where they don’t qualify for a tax credit under the state health insurance exchange while also failing to meet Idaho’s Medicaid eligibility requirements, Armstrong said. Most of these are adults without children or single-parent families who fall just short of 100 percent of the federal poverty line.

Idaho’s GOP hesitancy to tackle Medicaid expansion, a provision under the health care reform law known as Obamacare, has been prevalent ever since the U.S. Supreme Court left the expansion option up to the states.

Furthermore, many lawmakers who voted in favor of the state-based exchange, another provision under the 2010 federal law, were then targeted by far-right challengers and tea party groups and did not want to open them up to more criticism during this year’s primary election cycle.

“There’s no desire to touch this thing,” said House Majority Leader and committee member Mike Moyle of Star.

Lawmakers haven’t shown an openness to look past “philosophies” and address overhauling the entire Medicaid system, said state Rep. Tom Loertscher, R-Iona, who is also on the panel. During the most recent legislative session, Loertscher said he invited lawmakers to talk about Medicaid redesign, but only three out of the 105 legislators met with him.

“If we can’t get them to talk about the issues, nothing will happen,” he said. “The track we’re on now is not a good one. … The Legislature is prone to act only when their back is to the wall.”

Moyle later added that maybe the group should look again at reforming the state’s catastrophic fund, a program that relies on state and county funds to pay for indigent care, as a more palatable option lawmakers would be more willing to take on.

Other members quickly pointed out that past recommendations have strongly encouraged scrapping the catastrophic fund altogether.

The work group also listened to presentations on what other states are pursuing.

While 23 states have chosen to use the traditional voluntarily expansion option, a handful of states are pursuing alternative ways such as having Medicaid participants buy commercial coverage on the state’s health insurance exchange, said Joanne Jee, program director with the nonpartisan National Academy for State Health Policy.

For example, Arkansas implemented this model by using Medicaid dollars to subsidize people who purchased private coverage through the insurance exchange, Jee said.

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