March 24th: Will the Legislature Honor the Will of the People?
As we near the end of the 2019 legislative session (likely the end of this week or the week of April 1st), we still have some big issues to resolve. By far the top issue is what to do about Medicaid Expansion. I am a little worn down by all the wrangling, so this newsletter will be a little shorter than previous ones.
Medicaid Expansion (Proposition 2) and Sideboards
In short, the Senate is considering two competing bills on Medicaid Expansion, each of which places restrictions on access to Medicaid coverage, and, the House is holding hostage the appropriations bills that would fund Proposition 2. I do not foresee an easy way to satisfy the competing demands of these very different bills while still honoring the people’s intent. It is possible that resolution of the issues will be assigned to a conference committee. Below is a description of all the moving parts and options for the Legislature.
Option 1: The Senate has already passed funding bills for Medicaid Expansion, which is needed to fund the services provided by Proposition 2. If the House also passes these funding bills, the Legislature can adjourn and go home. This would be the best result, and I urge the House leadership to allow votes on those funding bills.
Option 2: SB1204, which was passed in the Health and Welfare Committee last Thursday, will likely come up for a vote in the full Senate on Monday. This bill includes only modest sideboards on Proposition 2, and would make Idaho’s implementation of Medicaid very similar to Montana’s successful program by adding voluntary participation in work-related services. These services will provide pathways to the participants’ employment in their communities, including access to job search tools, career coaching, job training, and educational opportunities if they choose to use them. I can support this bill.
Option 3: The House passed HB277, a highly controversial bill, that adds significant and obstructive sideboards to Medicaid Expansion. In my judgement this bill is an affront to the people of Idaho, when 61% voted in favor of Medicaid Expansion. I do not support this bill. Here’s why:
The work requirements included in this bill will mean thousands of citizens will not receive Medicaid, and anywhere from $1.5 million a year to $7 million or more of taxpayer dollars will be spent in needless bureaucracy. For example, this program will require 19 new full-time employees, 18 of them to manage the work requirement alone! This is an absurdly expensive requirement for the small number of people who will be subject to it.
The requirement to keep those who are at 100 to 138 percent of the poverty level on the state exchange, rather than have them covered under Medicaid Expansion (as Proposition 2 specified), ignores the portion of the Affordable Care Act that disqualifies a spouse from buying health care insurance on the exchange if a spouse’s employer offers coverage, but that spousal coverage is unaffordable. This requirement will leave thousands of Idahoans uninsured, not because they won’t get insurance, but because they can’t. This restriction will cost the state more, not less.
The new language on family planning will apply not just to the Medicaid Expansion population but to all Medicaid recipients, and will create more bureaucracy and more expense, in part by preventing women on Medicaid from seeing a gynecologist without a referral from a primary-care doctor designated as their medical home.
Proposition 2 was focused on trying to do good things for good people. HB277 fundamentally denies the will of the people. HB277 defies the good intent of that ballot measure, and creates more bureaucracy (not less), will cost more (not less), and will do bad things to good people.
Senate Health and Welfare Chairmen Fred Martin has indicated he will not hold a hearing on this bill, and it is not on Monday’s committee agenda. I hope it dies in committee.
The Voter Revenge Act Passes the Senate
On Friday the Senate passed SB1159. The vote was very close, with 10 Republicans and 7 Democrats only one vote shy of defeating the bill. I spoke against the bill on the Senate Floor and wrote extensively on it in last week’s newsletter. The bill now goes to the House and then, perhaps, to the Governor. I urge you to contact Governor Little and Representative’s Troy and Goesling to express your strong opposition to this measure that will highly restrict political action by Idaho citizens.