Legislators: Don’t ram through Medicaid expansion at the last minute

Fred Birnbaum Articles

At the last moment, new draft legislation, the Idaho Accountable Care Waiver Act, is being advanced. One should not be fooled, this act is much like the old SB 1204 reincarnated, with the same faults.

The gist of the Waiver Act: Idaho Health & Welfare Director Richard Armstrong would be required to apply for a waiver from the U.S. Department of Health and Human Services’ (HHS) Center for Medicare and Medicaid Services to develop a managed Medicaid program for people whose modified adjusted-gross income is below 100 percent of the federal poverty line and who are not already eligible for Medicaid.

If a waiver is granted the only obstacle for creating said program would be a concurrent resolution approved by the Idaho Legislature.

So, we are back to square one with a push for Medicaid expansion despite recent data from 17 other states which shows that each state that has enacted a similar expansion has surpassed enrollment projections and, therefore, has exceeded projected costs of expansion.

The notion that getting a Section 1115 (or a section 1915 (b)) waiver from HHS has any meaning is belied by the experience of other states like Arkansas, as detailed in an August 8, 2014 GAO report. Rather, the waiver is just a smokescreen for eligibility expansion – to able bodied adults. The terms and conditions of the waiver are not clear in Idaho’s last-minute-pushed legislation; and, it means nothing that the bill states that the waiver sought must “clearly articulate accountability.”

(One other curious thing, the proposed legislation calls for expansion up to 100 percent of FPL. However the 100 percent of Federal Poverty Level (FPL) may simply be the floor to get to the 133 percent, which then becomes 138 percent of FPL when “the 5 percent income disregard” automatically gets tacked on.)

Earlier this session, two like-minded bills were introduced, SB 1204 and SB 1205, but they were never voted on in committee. SB 1204 was a pure expansion of Medicaid; those who qualified could have had incomes up to 133 percent of the FPL. The other bill, SB 1205, expanded Medicaid eligibility for those who earned up to 100 percent of FPL; premium assistance would go to those in the 101 to 133 percent range of FPL, they could purchase insurance through the Idaho Health Insurance Exchange. Last session, this hybrid was named the Healthy Idaho plan.

One obstacle to gaining support for the Healthy Idaho plan? No surprise: the cost.

A year ago, Armstrong told the Legislature that his hybrid Healthy Idaho Medicaid expansion program would save the state $173 million over 10 years. A year later, Milliman, the actuarial firm, updated its study and determined that the same plan would actually cost Idaho $187 million over the next 10 years. That is a $360 million swing.

So there we have it, a thinly veiled Medicaid-expansion proposal, akin to Senate Bill 1204, is again being pushed by some legislators. The only real difference between the old bill and the so-called new Idaho Accountable Care Waiver Act: the words employed. The description of the old legislation was “to expand Medicaid eligibility” and the just-proposed Act is to “provide for managed Medicaid services.”

This really isn’t a horse of a different color; rather, it’s a Trojan horse for full-blown Medicaid expansion. Idaho lawmakers should take their time and exercise caution, and should not rush such an important decision.