The Idaho Republicans are working to roll the medicaid expansion approved by their constituents in November another case of GOP lawmakers who refuse to accept a democratic mandate to extend health care to their constituents during the economic care law. and a reminder of the complicated legacy left by the Supreme Court's 2012 health legislation decision.
The referendum in Idaho voted overwhelmingly in November, 61 percent to 39 percent. The initiative called for a no-frills expansion, extending eligibility to 138 percent of federal poverty levels ($ 17,200 for an individual, $ 29,400 for a family of three), as written in ACA. If implemented, it will offer health insurance for approx. 1
But during a bill held by the Idaho House on Thursday, the Medicaid eligibility would only be partially extended, up to 100% of the poverty level. People above this threshold (about 40,000) were required to purchase private coverage through the state insurance marketplace created under ACA instead.
In addition, Medicaid beneficiaries would have to work 20 hours a week, look for work or be in school to continue receiving benefits. Exceptions would be made for children, the elderly, parents and persons "physically or intellectually unfit for employment." If a person did not comply with this work requirement, they would lose their insurance coverage for two months before being allowed to recycle to Medicaid.
There was bipartisan opposition to this plan in Idaho House, but the bill was still going smoothly because of the overwhelming Republican majority. The Idaho Senate promotes its own plan which preserves the full Medicaid expansion and contains only a provision that helps recipients access job training and other work-related activities. Benefits would not be dependent on the work, as in the house bill.
Newly elected Head of Government Brad Little, a Republican, has said he supports Medicaid expansion, but that "we will not have incentives for people who do not work." The voting initiative adopted by the electorate had demanded that the state submits a Medicaid expansion plan to feds within 90 days of the referendum, but it has been delayed as legislators seek to change enlargement more to their liking.
Republicans find it difficult to expand Medicaid, even when voters will
CNN revealed this week a little more about the story that led to the Medicaid enlargement becoming optional – setting the kind of debate we see in Idaho. Enlargement was to be mandatory, but conservative led states challenged that provision along with the rest of the law in the 2012 lawsuit that established Obamacare's constitutional character.
In the Supreme Court, chief lawyer John Roberts, according to CNN's Joan Biskupic, originally stated that Medicaid expansion could be required, as ACA originally prescribed. But when he was looking for a way to uphold the rest of the law – including the individual mandate that he originally voted against – Roberts came to negotiate with the liberal righteous who acted the individual mandate of enlargement. The mandate was allowed to stand and the rest of the law with it, but Medicaid expansion was ruled as optional. States could not be forced to accept it – and in the last seven years it has been an important point of debate in state houses. Republican-led lawmakers in 14 states have still refused to extend Medicaid, leaving more than 1 million people without health coverage.
The votes have increasingly taken the matter into their own hands with ballot papers such as that in Idaho. Maine, Utah and Nebraska have also voted to extend coverage over the past two years, but in almost all cases, Republican officials have tried to override this vote.
The fight in Idaho follows the same bow as the previous debate in Utah, where voters approved a full Medicaid expansion, and then Republican politicians tried to regret it. The Utah Legislator approved a partial Medicaid expansion plan with the addition of a work requirement; The Trump administration is expected to decide whether the government's proposal should be approved any day now.
Legal challenges are likely to be expected if these changed Medicaid expansion plans are approved in Washington, DC. As Vox previously reported:
Two states, Arkansas and Massachusetts, have already asked the Trump administration to allow them to switch to a partial Medicaid expansion, covering people up to 100 percent of the poverty line. People above this threshold would have to buy cover through the private insurance markets created under the health legislation.
But these states have not received federal approval, with Trump's health department remaining silent on this issue. As the New York Times Robert Pear reported last summer, administration officials have discussed the issue of expansion carefully, and some argue in favor (to stave off states like Utah that decide to fully expand Medicaid) while others refuse to do anything proactively that would help expand Obamacare's coverage for more people.
Massachusetts could then sue if Utah's waiver is approved. Disputes are likely to follow from voters if the Utah Republicans continue their plan. The state could enter a legitimate land mine – all to extend the health insurance to fewer people than the plan already approved by state voters and at a higher starting price.
But it has not stopped the Idaho Republicans from going down the same road and seeking to turn the electorate's willingness to provide fewer of their poorest residents with insurance.