Idaho’s health coverage gap still unaddressed as lawmakers push toward adjournment

Health care advocates rallied at the Idaho Capitol on Thursday, calling for lawmakers to take back up Gov. Butch Otter’s health coverage gap proposal, which was pulled from the House floor without a vote two weeks ago.

But lawmakers are showing few signs that they’ll do so. They’re pushing hard to adjourn this year’s legislative session as soon as next week.

“I’m not going to make any optimistic statement on this matter,” said House Speaker Scott Bedke, R-Oakley. “I think the Legislature feels like they have dealt with this matter. Not everyone is happy, obviously, but I think there was general agreement there is not consensus enough to move the issue forward.”

The bill would allow about half of the 78,000 Idahoans who now fall into a coverage gap to qualify for subsidized insurance through the state insurance exchange, while also moving 2,500 to 3,500 of the sickest Idahoans off exchange plans and into Medicaid, to create the savings to pay for the plan.

“You, I, our politicians, all of us need to be reaching these people in the coverage gap,” Dr. Ryan Billington, a psychiatry resident from Coeur d’Alene, told a crowd of about 130 protesters, who held signs with slogans including, “You have a Rolls Royce plan – we have nothing” and “Save the plan.”

“These are our loved ones and my patients,” he said. “This is a crisis for us, individually and collectively as a state.”

Because Idaho never agreed to expand Medicaid under the Affordable Care Act, which it could have done largely at federal expense, about 78,000 residents of the state fall into the gap: They make too much to qualify for Medicaid but not enough to qualify for subsidies to purchase insurance policies on the exchange.

Otter’s bill would allow only those who make less than 100 percent of the federal poverty level to qualify for subsidies through the exchange. That’s about 35,000 people.

On Thursday, Otter said he thought the plan, which proposes seeking two waivers from federal authorities, was Idaho’s “last best hope” to address its coverage gap, and said he’s been trying to make that case to lawmakers.

But asked if he thought lawmakers would still take up his bill before they adjourn this year’s session, Otter said glumly, “I don’t see it.”

On Wednesday, House and Senate Democrats held a news conference calling for the Legislature to take action on the gap before it adjourns for the year.

“We still have a week left,” said Rep. Ilana Rubel, D-Boise.

She and Sen. Maryanne Jordan, D-Boise, said two bills remain pending in the current legislative session to address the coverage gap: Otter’s bill and Jordan’s own personal bill to fully expand Medicaid under the Affordable Care Act, which has been introduced in the Senate but hasn’t advanced.

“We are calling for either option at this point,” Jordan said. “Our call is to not let this session end yet again with no action on the gap population. Whichever of those can be discussed and debated and passed through this body, we are willing to have that conversation.”

The two lawmakers said Idaho will foot the bill for catastrophic care that’s needed by those in the gap regardless, through the state’s Catastrophic Health Care program, which has seen a big jump in cases this year. Through that program, local property taxpayers and the state general fund cover major medical bills that Idahoans can’t pay; the program also goes after the patients’ assets, and even their estates after they die, seeking repayment, though little is collected.

Jordan said, “The reality is, as we have heard from the federal government just in the last couple of weeks, the Affordable Care Act is the law of the land. So our charge as legislators is to function within that law, and to do what we need to do to help 78,000 Idahoans who fall within the gap.”

Bedke said if the Idaho Health Care Plan bill came up for a vote in the full House now, “There would’ve been a fairly emphatic vote” against it.

He said holding off now keeps the proposal alive in the longer term. “I believe the distance from a ‘maybe’ to a ‘yes’ is shorter than the distance from ‘no’ to ‘yes.’ ”