A Second Opinion

Sometimes in healthcare, we seek a second opinion.

For some Idaho legislators, the memory of 61% of Idahoans supporting Medicaid expansion seems to have faded just four months after the November election. Last week, they received a second opinion.

In a statewide poll conducted in late February, Idahoans were asked if they believed the legislature should implement the will of the people, or change the law that was passed by voters. An overwhelming 74.3% of Idahoans said, “Implement the will of the people.”

Despite that strong, and growing, support among Idahoans for implementing Proposition 2 as passed, a lot of “sideboards” have been discussed since the election. I always thought sideboards were designed to help keep things in the wagon. But, it is clear that those designing these legislative sideboards are doing it to keep people out of coverage.

One barrier to coverage would be a mandatory work requirement. This would involve the state spending millions to track the work, training or education of those who receive Medicaid. In addition to working two or three part-time jobs to make ends meet for their family, those low-income workers would then have to catalog those hours and report them to the state. The state says it will cost at least $2 million to track the activities of working Idahoans on Medicaid.

Rather than implementing costly and burdensome reporting requirements, other states have focused on training and education opportunities for their Medicaid recipients. In Montana, 58% of the participants in their work promotion program increased their wages by an average of over $8,000 annually.

Idahoans clearly prefer less red tape and regulations. 67% of Idahoans supported work promotion programs that help Idahoans better their lives. Only 22% of Idahoans supported a costly, mandatory work requirement.

And, as Idahoans considered the added costs to set up systems that deny and limit access to healthcare coverage, they felt any extra state dollars would be better spent on education or infrastructure, rather than more bureaucracy.

Meanwhile, the one thing the Legislature needed to do – appropriate funding for the state’s 10% match – seems to be moving along without any controversy. On Wednesday, February 27, the Joint Finance and Appropriation Committee set the overall Medicaid budget for FY2020, and included $9 million in General Fund and another $10 million from the Tobacco Settlement Fund to cover the state’s share of Medicaid expansion.

That appropriation bill will first go to the Senate where it is expected to pass easily. By all accounts, it will then become a “hostage” on the House side as certain members attempt to push for additional “sideboards” on Medicaid expansion eligibility and enrollment.

Today, eight weeks after the start of the legislative session, the first “sideboard” bill emerged. Representative John Vander Woude of Meridian introduced a bill that runs completely counter to the second opinion Idahoans gave the legislature last week. Rather than implementing the will of the people it would:

  • Shorten the time period from 90 days to 30 days for providers to determine income levels and enroll uninsured patients in Medicaid. This shortened enrollment period will cost hospitals millions of dollars in uncompensated care and leave Idahoans uninsured.
  • Add a mandatory work requirement for all able-bodied adults receiving Medicaid.
  • Mandate a sunset of the expansion program if Congress adjusts the 90/10 federal/state match downward. Include drug screening as part of the Medicaid enrollment process.
  • Fundamentally change the intent of Prop 2 by splitting the expansion population into two groups: 0-100% of the Federal Poverty level, and 100-138% FPL.
  • Allow for Medicaid dollars to be used for treatment of behavioral health patients at hospitals previously excluded from the Medicaid program – the one element of the bill that is not a barrier to coverage.

There’s a reason every Idaho Hospital supported Proposition 2 and why we now push for implementation without costly, bureaucratic restriction that limit enrollment or create additional barriers to coverage.

The people have spoken – twice – and said Medicaid expansion is good medicine for Idahoans!

Photo of Brian Whitlock, President / CEO, Idaho Hospital Association, Boise, Idaho
Brian Whitlock, President/CEO
March 4, 2019