Idaho Republicans seek to limit Medicaid expansion against the will of voters

Republican lawmakers are considering adding work requirements, co-pays, and lifetime limits.

Idaho demonstrators protest in front of the statehouse Monday in opposition to Republican efforts to limit Medicaid expansion. (Credit: Screenshot, KIVI Boise)
Idaho demonstrators protest in front of the statehouse Monday in opposition to Republican efforts to limit Medicaid expansion. (Credit: Screenshot, KIVI Boise)

Idaho Republicans are looking into several proposals aimed at hobbling a successful ballot initiative to expand Medicaid in the state, joining a growing list of red states trying to limit health care coverage against the will of voters.

Republican lawmakers have considered plans to apply work requirements, co-pays, and lifetime limits. They also plan to ask the Centers for Medicare and Medicaid Services (CMS) to grant the waivers before the ballot initiative goes into effect on Jan. 1, 2020. The request will likely delay implementation, as CMS is unlikely to take action. (The agency has never granted Medicaid expansion waivers in the past to any other state.)

“The purpose of Medicaid is to help people advance their situation,” said Rep. Brian Zollinger (R) according to the Idaho Statesman. “We think these requirements will help incentivize people to improve their lives.”

But voters are incensed. On Monday, more than 300 demonstrators protested in front of the Idaho Statehouse, urging lawmakers to allow a clean Medicaid expansion to go through.


“Idaho’s voters made it very clear they want Medicaid expansion in our state. Now it is time for our elected representatives to respect and enact the will of the people,” said Tracy Olson, co-organizer of the protest, according to the Associated Press.

“Medicaid expansion should be funded as the law was written, without restrictions to enrollment. Let the ‘Idaho way’ be one that is cost effective, evidence based and does not add wasteful bureaucracy.”

Idaho was one of three states last November, along with Utah and Nebraska, to vote in favor of ballot measures to expand health care for upwards of 62,000 low-income residents.

On Monday, the Utah Senate advanced a bill that would cap the pool of people eligible for Medicaid coverage and would end up costing the state seven times more than the ballot measure. Idaho Republicans have also considered this possibility.

More than 60 percent of voters cast ballots in favor of the Idaho ballot measure, which would expand Medicaid to include anyone earning less than 133 percent of the federal poverty level. Under the Affordable Care Act, the federal government pays 90 percent of the cost of coverage for states that expand their Medicaid programs to people earning up to 138 percent of the federal poverty line. Idaho still qualifies for federal funding despite this distinction, as the ACA also includes a 5 percent “disregard” with respect to income limits.


For now, Idaho lawmakers may hold off on introducing any of their bills, as they await a state Supreme Court ruling on a lawsuit filed by the Idaho Freedom Foundation to block implementation of the ballot measure. The court heard arguments on the suit this week.