BOISE — The House Health and Welfare Committee recommended passage of a bill that would result in low-cost insurance for tens of thousands in the Medicaid Gap.
The proposal, officially called the Idaho Health Care Plan, involves two waivers from the provisions of the Affordable Care Act. It passed Wednesday in a narrow 7-5 vote, gaining support from both Democrats and moderate Republicans, but opposed by members of the Idaho Freedom Caucus and others in the further-right portion of the Republican caucus.
Rev. Andrew Kukla, pastor of First Presbyterian Church in Boise, said the bill offered lawmakers a chance to answer a question.
“Do we care?” Kukla asked. “Do we want to send a message to the people we have left at the perimeters of our society to be devoured by the predators of life that we care about them? Or do we want to say it’s too inconvenient; it’s too expensive.”
Earlier this year, Gov. C.L. “Butch” Otter and Lt. Gov. Brad Little signed an executive order allowing plans that don’t meet the ACA’s minimum coverage requirements to be sold in Idaho. While officials have sometimes presented these policies as a package, the Idaho Health Care Plan doesn’t rely on and is quite different from the policies authorized under the executive order.
The executive order doesn’t require federal approval and will take effect regardless of whether the Idaho Health Care Plan passes or fails.
The Idaho Health Care Plan would involve securing one waiver that would allow between 2,500 and 3,500 individuals with very high-cost medical conditions such as metastatic cancer and hemophilia to apply for Medicaid in an effort to cut premiums in the individual market. This waiver, which functions like a high-risk pool, is estimated to reduce monthly premiums in the individual market by one-fifth.
Russ Barron, director of the Department of Health and Welfare, testified that the department had reviewed the networks of the high-cost patients the state wants to move to Medicaid, and found that in 94 percent of cases those individuals’ existing doctors also accept Medicaid.
A second waiver would extend the subsidies Idahoans with higher incomes use to purchase insurance on Your Health Idaho to those in the Medicaid gap. Department of Insurance Director Dean Cameron has indicated that with the subsidies many in the gap could obtain comprehensive health insurance for between $25 and $40 per month, an amount many in the gap could afford despite low incomes. This provision would extend to Idahoans the same benefits currently available to green card holders.
“The goals of this proposal are to assist those who are priced out by lowering the cost of insurance, and to help those who are left out by waiving the unfair rules of Obamacare,” Cameron said.
Cameron warned that Idaho’s individual market currently faces conditions commonly referred to as a “death spiral,” though he didn’t use that term. As the individual market came on line, the group of patients in it were sicker than anticipated. That meant insurers seeking premium hikes to cover higher-than-expected costs, and higher premiums provide a disincentive for healthy people to sign up. With fewer healthy people in the market, the pool becomes higher cost on average, leading to another round of premium hikes and so on.
Cameron said the dual-waiver proposal would arrest that spiral in two ways: Removing some of the highest-cost patients from the pool, and bringing in a larger group of lower-cost patients.
Over three hours, a variety of groups and individuals gave testimony on the proposals. The vast majority of testimony, including from patients in the gap, hospitals and doctors, supported the plan, though some libertarian-leaning groups, including the Idaho Freedom Foundation and Health Freedom Idaho, testified in opposition.
Fred Birnbaum, vice president of the Idaho Freedom Foundation, urged lawmakers not to introduce the bill, saying it amounted to Medicaid expansion and a bailout for insurers.
Yvonne Ketchum-Ward, CEO of the Idaho Primary Care Association, said her group supports the bill.
“This isn’t a perfect proposal for our patients, but it’s much better than what they have now,” she said.
Representatives of the Idaho Medical Association, the Idaho Hospital Association, Blue Cross of Idaho, Disability Rights Idaho, the Shoshone-Bannock Tribes and the American Association of University Women, among other groups, testified in favor of the bill. So did several of those in the gap, as well as individuals with disabilities.
Bernice Olivas, a woman in the gap, testified that her husband developed kidney disease due to uncontrolled diabetes. He now faces dialysis for the rest of his life, which is projected to last only a few years. If he had been able to access health services to control his diabetes, she said, he would have lived much longer. And the family wouldn’t be presenting $90,000 in medical bills that they can’t pay to be picked up by taxpayers.
Another woman in the gap, Cheryl Slavin, who suffers from multiple anxiety disorders, broke down while testifying.
“I need to stay out of the hospital,” she said. “I work, and I would like to continue doing so. But without my medications, I am disabled and a likely candidate for repeated hospitalization.”
Chairman Fred Wood, R-Burley; Rep. Kelly Packer, R-McCammon; Rep. Christy Perry, R-Nampa; Rep. Eric Redman, R-Athol; Rep. Jarom Wagner, R-Caldwell; Rep. Sue Chew, D-Boise; and Rep. Ilana Rubel, D-Boise voted to recommend the bill.
Rep. John Vander Woude, R-Nampa; Rep. Megan Blanksma, R-Hammett; Rep. Karey Hanks, R-St. Anthony; Rep. Mike Kingsley, R-Lewiston; and Rep. Bryan Zollinger, R-Idaho Falls voted to kill the bill in committee.
If the plan wins passage in the House and later in the Senate, that isn’t a guarantee the plan would be implemented. While Otter has championed the proposal and is widely expected to sign it, since it relies on federal waivers, the Centers for Medicare and Medicaid Services will have the final say on whether to grant the waivers.