[Vision2020] Idaho Senate sends Medicaid sideboards bill to House

[Moscow Cares]

Courtesy of today’s (April 3, 2019) Lewiston Tribune.

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Senate sends Medicaid sideboards bill to House
Mandatory work requirements, co-pay payments part of additions

BOISE — After weeks of discussion and behind-the-scenes negotiations, the Idaho Senate approved a Medicaid expansion “sideboards” bill Tuesday that includes mandatory work requirements and other restrictions.

The 20-15 vote capped an hourlong debate on an issue that has generated enormous public outcry all session long.

“I’m very sad about what we did today,” said Sen. David Nelson, D-Moscow, following the afternoon floor session. “We didn’t respect the will of the voters, (and) we just invited another lawsuit.”

The measure imposes several restrictions and conditions on Medicaid expansion, most of which need federal approval before they can be implemented.

The proposed sideboards include a mandatory work requirement of 20 hours per week. Anyone who fails to meet the requirement would still be eligible for Medicaid services; however, they would have to pay a $5 to $30 co-pay for each office visit for a period of six months, or until they met the work requirements.

Language was added requiring expanded Medicaid participants to be placed in a managed care system, as a way to help control costs. People earning 100 percent to 138 percent of the federal poverty level would also have the option to buy subsidized health insurance through the state insurance exchange.

“That helps those who may want to retain their private insurance plan,” said Sen. Mary Souza, R-Coeur d’Alene. “This waiver has the potential to save the state $3 million to $5 million, depending on how many people choose to stay on the exchange.”

The overall cost of these sideboards remains a point of contention. Souza admitted that all of the numbers are sketchy, given uncertainty about the number of people who sign up for expanded Medicaid.

Sen. Steve Thayn, R-Emmett, said administering the work requirements program could cost $1.6 million per year. However, if it somehow encourages 400 people to get jobs and work their way out of poverty, it could eventually save the state money.

“One of the weaknesses of federal poverty programs for the last 40 years is that you have to stay poor to maintain eligibility,” he said. “They aren’t designed to help people pass through poverty. The only way out of poverty is through work.”

Nelson, together with Sen. Carl Crabtree, R-Grangeville, opposed the legislation, as did Ray Mosman, who is filling in for Sen. Dan Johnson, R-Lewiston.

“If I were in charge of this body, I’d kill this legislation now,” Nelson said while debating against the bill. “What I’d do over the next year is try to gather some real data on how Medicaid expansion is working, and whether being healthier leads to our citizens working more. I’d let other states spend resources on lawsuits and work requirements. I’d respect the voters who asked us to implement straightforward expansion, with a 61 percent majority. I only got 56 percent of the vote in my district. I couldn’t do better than the initiative, and I won’t vote to change it now.”

After the floor vote, Crabtree said his constituents are divided on the whole sideboards issue. Some don’t want any restrictions, while others want even stricter requirements.

“I don’t have any (constituents) who support this bill,” he said. “They either want some serious work requirements, or none.”

The bill includes a number of exemptions to the work requirements, including anyone under the age of 19 or older than 59, pregnant women, parents with children under the age of 18, anyone taking care of someone who is disabled or seriously ill, as well as people who are receiving unemployment benefits.

Sen. Jim Rice, R-Caldwell, said the multiple exemptions effectively mean the requirement only applies to an able-bodied individual who doesn’t have any other obligations.

“This (proposed sideboard) denies coverage to no one,” he said. “But it does say if you’re able-bodied, then get a job and help pay for the care you’re receiving. Have some skin in the game; don’t just freeload on your neighbors. That’s an important principle.”

Sen. Jani Ward-Engelking, D-Boise, questioned how spending millions of dollars administering legally tenuous work requirements is actually an improvement over straight Medicaid expansion.

“I’ve heard over and over how we pride ourselves on fiscal responsibility,” she said. “But this mandatory work requirement will increase bureaucratic red tape, will need additional people to monitor it, and will drain millions of dollars every year from the general fund.”

Mosman, who has been substituting since Johnson had shoulder surgery last week, couldn’t get to yes on the measure.

“While I agree with the incentives this bill gives to citizens to keep working and to lift themselves out of poverty, I also think we have a responsibility to enact this as the citizens voted for it — especially as I am unelected,” he said. “Seeing 60 percent of them vote for this in my district compels me to vote no.”

The legislation now goes to the House, which previously adopted a stricter sideboards bill that was killed by the Senate Health and Welfare Committee.

The House Health and Welfare Committee will hold a hearing on the bill this morning. Assuming it gets out of committee, the full House could debate the measure as early as this afternoon; they could approve or reject it, or choose to amend it and return it to the Senate.

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Seeya 'round town, Moscow, because . . .

"Moscow Cares" (the most fun you can have with your pants on)
http://www.MoscowCares.com
  
Tom Hansen
Moscow, Idaho

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