- Associated Press - Friday, April 5, 2019

BOISE, Idaho (AP) - The Idaho Senate on Friday approved Medicaid expansion legislation by passing a compromise bill that’s now headed to Republican Gov. Brad Little for his consideration.

The Senate voted 19-16 on the legislation that was amended in the House to remove able-bodied people who don’t meet work requirements.

The previous Senate version allowed those people to retain Medicaid coverage but required a copay to receive medical care.

“It’s the best I think we could come up with,” Republican Senate Majority Leader Chuck Winder said after the vote. “We’ve been fighting for seven years around here about it. I think we finally got as close as we’re going to get.”

Voters authorized Medicaid expansion with an initiative in November that passed with 61% of the vote after years of inaction by the Legislature.

The expansion will provide access to preventative health care services for an estimated 91,000 low-income residents. The federal government would cover 90% of the estimated $400 million cost.

“The fact that they can kick them off coverage is very upsetting to me,” said Democratic Sen. Janie Ward-Engelking. “To think that someone who is out of work is going to have money for a copay - I think that’s not true. I think we’re going to see them in the emergency room.”

Republican Sen. Fred Martin, who opposed the bill, said his research found copays could be up to $75. Other senators who favored the bill said most would be much less.

Idaho will have to get a waiver from the federal government to implement the work requirement.

Idaho would also need a waiver that would allow people to stay on Idaho’s health insurance exchange rather than receive Medicaid. Republican Sen. Mary Souza, who supported the bill, said the state could save up to $15 million.

It’s not clear that the federal government will grant the waivers. The bill includes language that Medicaid expansion will continue in Idaho if the waivers don’t happen.

Another part of the bill requires Idaho lawmakers to review Medicaid expansion if the federal government portion drops below 90%.

Opponents noted that the work requirement and allowing people to stay on the state’s health insurance could trigger lawsuits. Winder said that because the waivers would come from the federal government, it would likely be those agencies facing lawsuits and not Idaho.

The compromise bill took much of the session to form. The Senate previously passed an appropriations bill paying for Medicaid expansion as approved by voters with no work requirements. Little has included $20 million for the expansion in his budget.

But the House has refused to vote on the appropriations bill because many members want work and other requirements for Medicaid recipients. Two early bills intended to repeal the voter-approved law were killed in a House committee. Another House bill with work requirements died in a Senate committee.

“The Senate gave us a great foundational bill,” said Republican Rep. Bryan Zollinger after the Senate vote. “We added a few things to it, and so I think it’s a good compromise.”

Republican Sen. Jim Rice, during debate on the Senate floor, said adding work requirements was what voters wanted when they approved the initiative.

“They were told expressly by the proponents of the bill that it was for working Idahoans,” he said. “Not non-working Idahoans. It’s strange to me that we would then be told that Idahoans voted to not have any work requirements.”

The debate included dueling fiscal estimates on the cost, with opponents arguing it would cost millions to administer the work and other requirements. But a number of senators noted that those numbers would be hard to pin down until the program was up and running.

The initial estimates for the number of potential participants, for example, was just over 60,000

“Now we hear estimates that it could be 120,000 people,” said Republican Sen. Lori Den Hartog.

Democratic Sen. Grant Burgoyne, in voting against the bill, said there were too many unknowns and it wasn’t ready.

“I don’t see anything here in my own estimation that requires us to take action today,” he said.

Republican Sen. Mary Souza disagreed.

“We don’t come up with perfect laws,” she said in closing remarks to the debate before senators voted. “It’s better that we do it now and tweak it in the future.”

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