Bill Description: House Bill 201 would substantially expand Medicaid by increasing the income limit for participation and by creating a new expansion for postpartum coverage.

Rating: -7

NOTE: House Bill 201 is very similar to House Bill 122, introduced earlier this session. 

Does it create, expand, or enlarge any agency, board, program, function, or activity of government? Conversely, does it eliminate or curtail the size or scope of government?

Medicaid is one of the largest and most expensive government programs, always growing in size, scope, and spending, while increasing the people’s dependence on government and forcing private providers out of the market. 

House Bill 201 would amend Section 56-239, Idaho Code, to increase the threshold for participating in the "CHIP Plan B" program from 185% of federal poverty guidelines to 205% of federal poverty guidelines. This change means more people will be enabled and encouraged to participate in this redistributive program of socialized medicine. 

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House Bill 201 would amend Section 56-254, Idaho Code, to increase the threshold for participating in the "benchmark plan for low-income children and working-age adults with no special health needs" from 185% of federal poverty guidelines to 205% of federal poverty guidelines for children. It would raise the limit from 133% of federal poverty guidelines to 205% of federal poverty guidelines for pregnant women. This change means more people will be enabled and encouraged to participate in this redistributive program of socialized medicine.

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House Bill 201 would create Section 56-269, Idaho Code, calling for a "state plan amendment" to "extend medicaid eligibility for twelve (12) months postpartum to individuals who, while pregnant, are eligible for and receive medicaid, in accordance with section 9812 of the American rescue plan act of 2021 and section 1902(e)(16) of the social security act." This change means more people will be enabled and encouraged to participate in this redistributive program of socialized medicine.

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Does it transfer a function of the private sector to the government? Examples include government ownership or control of any providers of goods or services such as the Land Board’s purchase of a self-storage facility, mandatory emissions testing, or pre-kindergarten. Conversely, does it eliminate a function of government or return a function of government to the private sector?

Health care should be provided and obtained in the private sector. Any time individuals are enabled or encouraged to seek health care or health care subsidies through government, the private market for health care is weakened and the people’s dependence on government is increased. 

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Does it increase government redistribution of wealth? Examples include the use of tax policy or other incentives to reward specific interest groups, businesses, politicians, or government employees with special favors or perks; transfer payments; and hiring additional government employees. Conversely, does it decrease government redistribution of wealth?

Medicaid is funded through a combination of tax dollars and government debt. Any time individuals are enabled or encouraged to seek health care or health care subsidies through government, they are receiving services funded through redistribution.

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Does it increase government spending (for objectionable purposes) or debt? Conversely, does it decrease government spending or debt?

The Fiscal Note for House Bill 201 suggests that the costs for expanding Medicaid as proposed by the bill will be more than $35 million annually. History has shown that cost overruns are the rule rather than the exception with Medicaid, however. It is reasonable, then, to assume the costs will be substantially higher than this amount. 

Assuming a 10% rate of annual cost increase (which is a conservative estimate for Medicaid), the total cost over ten years for expanding Medicaid as proposed by the bill will be more than $550 million.

The fiscal note is unclear about how much each part of the expansion costs, whether it comes through expanding CHIP Plan B or expanding Medicaid, under 56-254, for lower income families and pregnant women. 

Finally, though the bill does contain a federal financial participation requirement, it only calls for a review if funding drops more than 10%; it doesn't trigger repeal.

(-1)

Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the Tenth Amendment. Conversely, does it restore or uphold the principles of federalism?

Most funding for Medicaid comes from the federal government, which means that as the program grows, the state becomes increasingly dependent on federal dollars, and those federal dollars become an ever larger share of the state budget. As has been seen with Medicaid and other federal programs, federal dollars come with strings that obligate the state to comply with policies and priorities that go against its best interests.

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