Lee Heider, Fred Wood, Dick Armstrong, C.L. "Butch" Otter

Senator Lee Heider, R-Twin Falls, speaks about the plans for the Idaho Primary Care Access Program along with Representative Fred Wood, R-Burley (left), Director of Health and Welfare Dick Armstrong (second from left), and Idaho Gov. C.L. “Butch” Otter, during the AP Legislative Preview at the State Capitol building on Jan. 7 in Boise.

BOISE • Medicaid expansion got its first-ever hearing in the Idaho Legislature Tuesday, but with another health plan from the governor’s office in the mix, the outcome is still up in the air.

Senate Health and Welfare Committee Chairman Lee Heider, R-Twin Falls, started the meeting by saying he wanted it to be an “information only” hearing with no motions.

He said it would put the committee in an awkward position to vote on Medicaid expansion now, given that the governor’s Health and Welfare’s plan to extend primary-care coverage to the uninsured is also expected to come up soon.

Sen. Dan Schmidt, a Democrat from Moscow, introduced two Medicaid expansion bills. One is for full expansion for everyone making up to 138 percent of the poverty level.

The second is the “Healthy Idaho” plan Gov. C.L. “Butch” Otter’s Medicaid Redesign Workgroup recommended in 2014, which would expand Medicaid to everyone under the federal poverty line and cover people who make up to 138 percent of poverty on the state insurance exchange.

For the past several years, state Democratic lawmakers have been pushing Medicaid expansion but the Republican Legislature hasn’t taken it up.

This year, Otter and the Department of Health and Welfare are proposing the Primary Care Access Program, or PCAP, as a way to extend some coverage to the uninsured. Heider said last week he would hold a Medicaid expansion hearing as a courtesy to Schmidt.

Hundreds of people filled the halls before the hearing, some wearing stickers saying “78,000 Can’t Wait,” in reference to the number of people estimated to fall in the “Medicaid gap.” Those are people who don’t qualify for Medicaid but are too poor to qualify for subsidized health care on the exchange. The vast majority of spectators couldn’t fit in the committee room, so most listened in two overflow rooms.

Mindy Hong, the director of the Pocatello Free Clinic, said 60 percent of the people her clinic treats fall into the gap.

“The people that we see are usually sicker than your normal population,” she said. “They’ve gone for a long time without care.”

But, the clinic can’t care for people with more serious or specialized problems and sometimes has to turn them away.

“Basically, we’re the last stop for a lot of people,” Hong said. “So if you can’t get care from us, you don’t get care.”

Hong said she appreciates Otter’s attempts to take care of the gap population but doesn’t think PCAP would help much.

“Really, I don’t see any difference between what’s being done now and what the governor wants to do with PCAP, because those financial barriers are not addressed in his program,” she said.

The committee heard about an hour of testimony, most from doctors who back Medicaid expansion and people who fall in the gap who told their stories. One was Chelle Gluch, a Nampa resident whose family is uninsured and whose husband and daughter both suffer from painful and mostly untreated stomach problems.

Gluch, a child care worker, said she and people like her keep Idaho running — store clerks, service industry workers — but have to choose between going to the doctor, paying their bills and filling their gas tank.

“With Healthy Idaho, the working poor will finally have some control over their lives,” she said.

Medicaid expansion supporters say it would save money by getting rid of state and county health care funds for the poor. The fiscal note attached to the “Healthy Idaho” bill says it would save $25.6 million for the state and counties.

The only person to testify against expansion was Fred Birnbaum, vice president of the Idaho Freedom Foundation. Birnbaum said it is unlikely the federal government would continue to cover 90 percent of the expansion cost forever, given the $18 trillion federal debt, and that accepting expansion would mean if the state tries to withdraw in the future, it could put all of Idaho’s Medicaid dollars at jeopardy.

“I don’t think we can assume that this is going to save the state money,” he said.

What happens now?

Heider said after the hearing they would have to see what Otter and DHW want to do and what the budget committee says it can afford. Heider said lawmakers are citizens first, and also want to find the right solution.

“We have empathy for the people just like you do,” Heider said. “We’re one of you.”

A DHW spokesman said last week he expected a PCAP bill to surface this week, but it hasn’t as of Tuesday, and Heider said he hasn’t heard when it will be introduced.

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