Wreath Medicaid

A funeral wreath, meant to commemorate uninsured Idahoans who die but might not die if they had insurance, placed in front of the Senate chambers by Medicaid expansion supporters on March 24, 2016.

BOISE • The Idaho House will meet again on Good Friday to vote on a bill that would have the director of the Department of Health and Welfare apply for a Medicaid expansion waiver, paving the way for an Idaho-run health program designed for the state’s working poor.

The Senate finished up for the year Thursday evening after passing both the waiver bill and a related funding bill. The House also passed the funding bill 40-29 Thursday evening before adjourning for the day, setting up Friday’s expected waiver debate.

Idaho lawmakers have been debating what to do about covering people in the “Medicaid gap” — some 78,000 of mostly working poor Idahoans who don’t qualify for Medicaid but make too much for health insurance subsidies on the state exchange — ever since a 2012 Supreme Court ruling left the decision on whether to expand Medicaid up to the states. A couple of state workgroups have studied the issue, but attempts at Medicaid expansion have gone nowhere, with many GOP lawmakers ideologically opposed to the Affordable Care Act and worried about the funding.

The proposal now is to come up with a waiver for a state-designed “managed care” plan, rather than the traditional fee-for-serviced model, that would cover people making under the poverty level. If the Centers for Medicare and Medicaid Service approve the state’s application Idaho could then get federal money to cover most of the cost of the program.

Now, it all comes down to Friday, when the House is also expected to adjourn after deciding whether to seek the federal waiver that would allow it to pursue its plan.

“Senators, we’ve been kicking this issue around for three sessions now, and it’s time for a reality check,” said Sen. Jim Guthrie, R-Inkom. “We truly need to fish or cut bait. More studies and more stalling are at a point where it’s disingenuous.”

Thursday started with a Senate committee considering a much different bill, one that would have created an interim committee to study devising a Medicaid waiver but would have forbidden Health and Welfare from applying for a waiver without legislative approval, effectively pushing the decision on whether to apply into the 2017 session and further pushing back the process of possibly setting up a program.

“I think we need to come up with a solution prior to Fiscal Year ‘18,” said Sen. Marv Hagedorn, R-Meridian.

The Senate Health and Welfare Committee killed that bill but left alive a companion bill to give $5 million a year in grants to community health clinics, which take care of many of the uninsured, and spend $400,000 to study the “gap” population.

Then, the Senate amended this bill to authorize DHW to apply for a waiver immediately and sent the new version back to the House. After the waiver is approved, the Legislature would need to approve the plan before it is implemented. That means lawmakers could implement a modified, state-designed version of Medicaid expansion earlier in the 2017 session with a waiver in hand, rather than waiting until then to even decide whether to seek one.

The managed-care concept now before the House was being discussed last week, but on Wednesday the House instead introduced and passed the interim committee bill and the grants for clinics-gap population study bill. The language of the current bill is closely modeled on what was being discussed last week.

Otter said Thursday he supports beginning the Medicaid expansion waiver application process as soon as possible.

“The sooner that we can start that, the better prepared we’re going to be” and the better we’ll be able to answer the questions about it, he said.Otter declined to say whether he would consider executive action if the Legislature doesn’t act, saying he wants to see what they do first.

Supporters of Medicaid expansion rallied on the Capitol steps Thursday morning to call on lawmakers to pass the “Healthy Idaho” expansion plan before the end of the session.

“Our Legislature does not care,” said Chelle Gluch, a Nampa resident whose family is uninsured and whose husband and daughter both suffer from painful and mostly untreated stomach problems. “What they proposed is a slap in the face.”

Ken Krell, an Idaho Falls doctor who took care of Jenny Steinke, whose death from asthma was well publicized and is used as an example of someone who died because of the “Medicaid gap,” listed off cases of people in the Medicaid gap who have come into his hospital and said they will “live and die in the gap because of the cruelty and heartlessness of our legislative body.”

Krell called on Otter to either call a special session to pass Medicaid expansion or take executive action to expand Medicaid, as has happened in some other states.

“Many Idahoans are being hurt as a result of their inactivity and dying as a result of their intransigence,” Krell said of the Legislature.

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