Legislature introduces Medicaid expansion repeal bill

After several legislative moves to punt decisions on Medicaid cuts this year, Idaho Republican lawmakers introduced a bill on Monday to repeal Medicaid expansion.

The bill would repeal Medicaid expansion on Jan. 1, 2028. That would remove roughly 90,000 Idahoans from the health insurance public assistance program. 

In 2018, nearly 61% of Idaho voters approved the policy through a ballot initiative to close a health care assistance gap affecting a population commonly called the working poor. 

In the past, Medicaid expansion repeal bills haven’t gone far in the Legislature. But this year, state lawmakers are pushing for deeper, across-the-board state government spending cuts — including to Medicaid disability services — after approving years of tax cuts that have reduced the state’s revenue by more than $4 billion. 

Rep. Jordan Redman, R-Coeur d’Alene, pitched the bill as an alternative to cutting Medicaid disability services. 

“Are we going to prioritize the most vulnerable way, in which Medicaid was originally set up for? Or are we going to look to continue with Medicaid expansion?” Redman asked the committee. 

After a motion to reject the bill narrowly failed, the committee introduced it. It could return for a public hearing soon.

Lawmakers delaying vote on Medicaid disability cuts is why the expansion repeal bill is here, committee chairman says

In Gov. Brad Little’s budget plan, he proposed $22 million in Medicaid cuts that could come from a range of service reductions. But Medicaid expansion wasn’t on that list. 

Last week, the House Health and Welfare Committee voted to shelve for a week a bill that would’ve cut nearly $22 million from a Medicaid disability service called residential habilitation. That delay was why committee chairman Rep. John Vander Woude, R-Nampa, asked Redman to bring the repeal bill, Vander Woude told the committee. 

“We have to decide whether we’re going to make our priorities those with disabilities or those without. And this is the only other option I have,” Vander Woude told the committee. He said his other bill died in committee. But the committee’s official vote was to hold the bill until March 11. 

Redman said there are several issues the Legislature can’t address due to budget constraints. He pointed to bills to reinstate a critical Medicaid program for severe mental illness and to reinstate a paid family disability caregiver program. In less than three months after Idaho cut the mental health treatment program, three patients died, the Idaho Capital Sun reported. 

Lawmakers debate whether repealing Medicaid expansion would save Idaho money

Since 2020, when Medicaid expansion took effect, Republican state lawmakers have said the program is straining the state’s budget. The Legislature’s DOGE task force recommended late last year repealing Medicaid expansion. Before this legislative session started, Idaho House Speaker Mike Moyle said he was open to repealing Medicaid expansion.

Redman’s bill’s fiscal note says people removed from Medicaid expansion will be eligible for tax credits to buy health insurance on the state’s exchange. 

Debating the bill in committee, Rep. Ben Fuhriman, R-Shelley, said he doesn’t believe that shift to the exchange would happen.

“I feel like this is going down a road that is going to cause a lot more harm than the money it saves,” he said.

Rep. Lucas Cayler, R-Caldwell, said Medicaid expansion “is absolutely going to blow out the budget in this state.”

“This does apply to able-bodied people that are capable of working,” he said. “There are entirely way too many people, able-bodied adults, who are not working and are not participating in any type of volunteer or additional educational opportunities for themselves.”

About 48% of non-disabled adults on Idaho Medicaid are working, according to a December report by the Idaho Department of Health and Welfare.

House Minority Leader Ilana Rubel, a Boise Democrat, said repealing expansion would cost the state more in the long run. She pointed to an analysis by the Department of Health and Welfare on the state’s extra costs from repealing expansion, and a report by a U of I economist, to say the state would have a net loss of at least $20 million over any potential savings.

Advocates react to Medicaid expansion repeal bill

Redman’s bill doesn’t include plans to reinstate indigent financial health programs that helped people without insurance pay for emergency care. After Medicaid expansion took effect, the Idaho Legislature repealed those programs — the county indigent health program and the state Catastrophic Health Care Fund, also known as the CAT Fund. 

“This bill will rip health care away from 90,000 Idahoans who rely on Medicaid expansion and have no other option for coverage,” Idaho Voices for Children Policy Director Hillarie Matlock said in a statement. “Idahoans voted for their neighbors to have healthcare — 61% approved Medicaid expansion. Ignoring that and taking coverage away goes directly against the will of the voters.” 

In a statement, American Cancer Society Cancer Action Network’s Idaho Government Relations Director Randy Johnson said more Medicaid cuts shouldn’t even be considered.

“The Medicaid budget cuts have already led to preventable death, and Washington border hospitals have reported Idaho residents arriving at their doors seeking the care they can neither access nor afford here,” Johnson said. “This is not the Idaho anybody should want. These cuts are a choice, not a necessity, and we will continue to add our voices to the tens of thousands who have been telling lawmakers the same thing for years now: Medicaid works and should be left in place for the next generation.